Skip to main content

Full text of "Public health papers and reports"

See other formats


This is a digital copy of a book that was preserved for generations on library shelves before it was carefully scanned by Google as part of a project 
to make the world's books discoverable online. 

It has survived long enough for the copyright to expire and the book to enter the public domain. A public domain book is one that was never subject 
to copyright or whose legal copyright term has expired. Whether a book is in the public domain may vary country to country. Public domain books 
are our gateways to the past, representing a wealth of history, culture and knowledge that's often difficult to discover. 

Marks, notations and other marginalia present in the original volume will appear in this file - a reminder of this book's long journey from the 
publisher to a library and finally to you. 

Usage guidelines 

Google is proud to partner with libraries to digitize public domain materials and make them widely accessible. Public domain books belong to the 
public and we are merely their custodians. Nevertheless, this work is expensive, so in order to keep providing this resource, we have taken steps to 
prevent abuse by commercial parties, including placing technical restrictions on automated querying. 

We also ask that you: 

+ Make non-commercial use of the files We designed Google Book Search for use by individuals, and we request that you use these files for 
personal, non-commercial purposes. 

+ Refrain from automated querying Do not send automated queries of any sort to Google's system: If you are conducting research on machine 
translation, optical character recognition or other areas where access to a large amount of text is helpful, please contact us. We encourage the 
use of public domain materials for these purposes and may be able to help. 

+ Maintain attribution The Google "watermark" you see on each file is essential for informing people about this project and helping them find 
additional materials through Google Book Search. Please do not remove it. 

+ Keep it legal Whatever your use, remember that you are responsible for ensuring that what you are doing is legal. Do not assume that just 
because we believe a book is in the public domain for users in the United States, that the work is also in the public domain for users in other 
countries. Whether a book is still in copyright varies from country to country, and we can't offer guidance on whether any specific use of 
any specific book is allowed. Please do not assume that a book's appearance in Google Book Search means it can be used in any manner 
anywhere in the world. Copyright infringement liability can be quite severe. 

About Google Book Search 

Google's mission is to organize the world's information and to make it universally accessible and useful. Google Book Search helps readers 
discover the world's books while helping authors and publishers reach new audiences. You can search through the full text of this book on the web 



at |http : //books . google . com/ 















;:::x;;;;::?:iili^^ 















!•*•. '-y,'''. '•'.''.**'. ''. 



.;:^^Aiilili^M 



ilikMiliUMUilliiyiuii^^ 



'••:":-:-.'">*^''.- 



>;-^x-. 






.%•::•• .•:•:•>' .•:•: 












,- .• .•/% .- .••• 






i 



PUBLIC HEALTH 

PAPERS AND REPORTS 



VOLUME XIX 



PRESENTED AT THE TWENTY-FIRST ANNUAL MEETING OF THE 



American |)ublit j^mltl) ^ssomixon 



CHICAGO, ILLINOIS, OCTOBER 9-14 



1893 



WITH AN ABSTRACT OF THE RECORDS AND PROCEEDmGS 



CONCORD, N. H. 
"Republican ^rcee "AyCe^ociaiion 

1894 



Copyright, 1894 
By Irving A. Watson, Sec. American Public Health Association 



All Rights Reserved 



NOTE BY THE SECRETARY. 



The papers published in this volume do not necessarily carry with them the endorse- 
ment of the Association. The authors alone should be held responsible for the state- 
ments made and the opinions expressed. 

The Chicago meeting was held under somewhat different circumstances than those 
of the preceding sessions of the Association. As a matter of history the arrangements 
for the meeting as announced in the preliminary circular of the secretary are here given. 

Sbcrbtary's Office, 
Concord, N. H., August i, 1893. 
(Preliminary Circular.) 

The twenty-first annual meeting will be held under a plan which will differ very 
materially from that of any former meeting of the A. P. H. A. Through an 
arrangement entered into by the World's Congress Auxiliary and this Assoaation, 
the forthcoming meeting will constitute an International Congress of Public Health, 
and committees are already at work to make it a grand success. Invitations have 
already been extended to foreign countries to participate in the meeting, and to 
the most prominent sanitarians throughout the world to present papers. 

The regulations which will govern this meeting are outlined in this circular. 
Particular attention is called. to the fact that the meetmg will be held in sections; there- 
fore, persons presenting papers will note under which section their papers will properly 
come. The classification given under each section will also suggest the topics upon 
which papers are desired. 

It is suggested that members who intend to visit the World's fair postpone their trip 
until the meeting of this congress, as there will be no better month in which to see the 
fair. Another circular will be issued before the meeting, giving additional particulars. 

The following is from the circular issued by the committee having in charge the details 
of the forthcoming meeting : 

This Congress will be in session in the Art Institute Building, Chicago, October 9-14, 

Membership in the Congress is open without fee to all persons interested in public 
health, who comply with the formalities of registration. 

The proceedings will be published by the American Public Health Association, and 
will be distributed to all members of the Congress, who, on the pavment of five dollars 
and election, may become members of the American Public Healtn Association. This 
payment of five dollars entitles the member to a copy of the proceedings, is the only fee 
required, and is entirely voluntary. 

Registration may be conducted in person or by correspondence, and it will facilitate the 
work of the Congress for this to be accomplished as early as possible. To that end an 
official will be present in the Art Institute to attend to registration every day during the 
preceding week, October 2-7, from 9:00 to 5:00 o'clock, and again on Monday, October 
9, during the same hours. Registration may also be accomplished later, according to 
placards in the hall. 

Correspondence on this subject majr be addressed to " The Registration Clerk, Public 
Health Congress, Art Institute, Chicago." Checks should be made payable to the 
Treasurer American Public Health Association. 

Registration consists in recording the name, including designating titles ; the official 
representation, if any; the permanent residence; and the local address (this maybe 
omitted or changed at discretion). The particular section the member wishes to work 
with will also be noted. No charge is made for registration. 

Special business meetings of the American Public Health Association will be held 
each morning, including Monday, October 9, and also at 4:00 p. m. Monday, October 9, 
for the election of members. 

The opening session of the Congress will be held in one of the large halls of the Insti- 
tute, at 8:00 p. m. Monday, October 9, and will be devoted to addresses of welcome by 



IV NOTE BY THE SECRETARY. 

the President of the World's Congress Auxiliary, bjr the Mayor of Chicago, and by the 
President of the American PuUic Health Association, and to responses by foreign 
delegates. These will be followed by the Inaugural Address by the President of the 
American Public Health Association. 

The mominss of Tuesday, Wednesday, and Thursday, from io:oo to 12:00 o'clock, 
will be devoted to discussions in general of the meetings of the Congresses upon the 
following topics : 

Tuesday — ^Diseases chiefly manifested in the air passages : Tuberculosis, Diphtheria, 
Pneumonia, their prevention or control through Public Health Service. 

Wednesday — ^Diseases affecting the alimentary canal : the Diarrhoea of Childhood, 
Cholera, Enteric Fever. 

Thursday— The Eruptive Fevers : Small-Pox, Measles, Scarlet-Fever, and the diseases 
of modem life due to nervous conditions. 

Friday morning will be given up to a business meeting of the American Public Health 
Association. 

The general meeting of Saturdav morning will close the Congress. 

The afternoons of Tuesday, Wednesday, Thursday, and, if necessary, Friday, will be 
devoted to the work of the Congress by sections as follows : 

I. International, National, and State Hygiene : Its Methods and Relations, includ- 
ing Vital Statistics. (" State," as nere used, indicates an autonomous part of 
a nation, as a kingdom of the German Empire, an integral State of the 
American Union.) 
II. Municipal Health Service. To include the control of the infectious diseases of 
men and animals, offensive trades, water-supply, the disposal of excreta, gar- 
bage, and the waste of manufactories, schools, and public assemblages. 
III. The nifectious Diseases of Men and Animals : Their Causes, Prevention and 
Control. 

There will also be general meetings of a popular character at 8 p. m. on Tuesday, 
Wednesday, and Thur^^, when addresses will be delivered on public nealth subjects of 
general interest. The object of these is to disseminate general information on such sub- 
jects as, — The prevention of infectious diseases; the causes of ill-health due to soil, air, 
and water; the health and sickness of self-supporters (workers). 

All papers that are offered must be received oy '' The Secretaries of the Public Health 
Congress, Chicago, III.," before September 15, 1893, and titles and abstracts of these by 
September i. 

Papers for the Congress not written in English should be accompanied by an English 
translation. 

The time for reading a paper in a section is limited to fifteen minutes, excepting when 
illustration is required or where special extension is granted, when five minutes may be 
added in each instance. 

Thirty minutes is the extreme limit of a paper in the general session. Members desir- 
ing to aiscuss subjects before the Congress must send their cards to the presiding officer 
in order to be recognized. The floor may not be occupied for more than five minutes. 

It is desired to make the Congress a demonstration of practical methods, and papers 
on elementary topics or theoretical views cannot be accepted. Papers bearing on the 
objects of the Congress are solicited from every source, but their acceptance must 
depend on the approval of the committees in charge of the Congress. These committees 
are guided in this matter by the standing rules of the American Public Health Associa- 
tion. Resolutions of praise or censure, or committing the Congress as such to special 
views, will be out of order. 

The President of the American Public Health Association, which embraces the Dominion 
of Canada, the Republic of Mexico, and the United Sutes, will be the President of the 
Congress. 

Honorary Presidents will be appointed from other countries. 

Vice-Presidents of the Congress and of the sections will be made from the countries 
represented. 

All persons from beyond the United States who anticipate being present, are requested 
to notify the secretaries as early as convenient. It will materially assist in the organiza- 
tion for the committees to be informed by October i of the Americans who expect to 
attend. 



TABLE OF CONTENTS. 



TWENTY-FIRST ANNUAL MEETING. 

PAGB. 

The Pbbsidekt'8 Addbess. By Samuel H. Dttbgin, M. D., Boston, Mass. 1 

ViCB-PBBSiDBirr'B Addbess. By Dr. Edtiabdo Lic^aga, President of the 
Superior Board of Health of Mexico, Mexico 13 

Addbess op Welcome. By Chables C. Bowwey, Esq., President of the 
World's Congress Auxiliary of the World's Columbian Exposition, 
Chicago, 111 15 

Remabks. By Mrs. Chables HENBonir, Vice-President Woman's Branch 

of the World's Congress Auxiliary, Chicago, 111 18 

Remabks. By Dr. A. R. RsTiiroLDS, Commissioner of Health, Chicago, 111., 19 

Bemabks. By Dr. Sabah Hackett Stevenson, Chicago, HI. . . .20 

Ah Expebiment in Disinfection— How an Epidemic op Pneumonia was 
Checked. By Jbbome Cochban, M. D., Health Officer of the State of 
Alabama, Mobile, Ala 21 

Notes on Choleba, and its Management in Hull. By John Weight 
Mason, M. B. C. M., D. P. H. (Abebd.), M. R. C. S., Eng. Medical Officer 
of Health; Surgeon, Hull Borough Police Force; Medical Superintendent, 
Hull Sanitarium; Medical Officer of Health, Hull & Coole Porte Sanitary 
Authority, Hull, Eng 25 

Tbopical DiABBHOfiA. By Surgeon-General Sir Joseph Faybeb, K. C. S. L, 
LL.D., M. D., P. R. S., Honorary Physician to the Queen; Honorary 
y ice-President of the International Congress of Public Health, Chicago; 
President of the Medical Board at the India Office, London; London, 
Eng 83 

Choleba Inpantum: Its Tbeatmbnt. By Manuel Septi^n, President 
Quer^taro, Mex 39 

The Sewage Disposal Pboblem in Amebican Cities. By Allen Hazen, 
Chemist in charge Lawrence Experiment Station, Massachusetts State 
Board of Health, Lawrence, Mass 44 

The Collection and Disposal op Animal and Vegetable Waste in 
THE City op Milwaukee. By IT. O. B. Wingate, M. D., Commis- 
sioner of Health, Milwaukee, Wis 49 

The Disposal op the Gabbage and Waste op the Wobld's Columbian 
Exposition. By W. P. Mobse, New York City 63 

National Reqistbation a Necessity. By S. W. Abbott, M. D., Secretary 
State Board of Health of Massachusetts, Boston, Mass dS 

Impobtance op Sanitaby Bubeaus; Theib Economic Obganism. By 

Dr. J. E. MoNJABls, San Luis Potosi, Mex 69 

Objects op the National Health Society op London. By Ebnest 
Habt, M. R. C. S., D. C. L., London, Eng 71 

LliTPLUENCE OP INEBBIETY ON PUBLIC HEALTH. By T. D. Cbothebs, M. D., 

Superintendent Walnut Lodge Hospital, etc., Hartford, Conn. . . 74 
Hygiene op Haib-Dbessebs' and Babbebs' Shops. By Dr. Angel Con- 
TBEBAS, Delegate from the State of Yucatan, Mex 81 



VI TABLE OF CONTENTS. 

Aotmal VACCimE— Wht it Should be Pbefbbbed to Human Vaccine. 
By Miguel Mabquez, M. D., Vice-President of the Board of Health in 
the State of Chihuahua, Mez 84 

Yellow Colobation op Pebsons Attacked by '* Vomito Pbieto." By 
Dr. Manuel Cabmona t Valle, Director of the National School of 
Medicine of Mexico; Professor of Internal Clinics; Member of the 
Academy of Medicine, Mexico, and several Scientific Societies, Mexico, 89 

The Canadian Quabantine System. By Fbedebick MontizaMbbbt, 

M. D. Ed.; F. R. C. S. E., D. C. L., Grosse Isle, P. Q 92 

Difficulties and Danoebs that have Pbesented Themselves in the 

QUABANTINES OF SEVEBAL POBTS OF THE MEXICAN REPUBLIC By 

Dr. Dominoo OBVAJtANOs, Mexico, Mex 104 

Quabantine. By S. R. Olifhant, M. D., President of the State Board of 

Health, New Orleans, La. 107 

The Quabantine System of Texas, by R. M. Sweabingen, M. D., State 

Health Officer, Austin, Tex Ill 

GoNSEBVATioN OF Nebve Fobces. By Mrs. Coleman Stuckebt, for the 

Public Health Congress 116 

Contbibution to the Study of Yellow-Fbveb fbom a Medico-Geo- 

GBAPHICAL AND PBOPHYLACTIC PoINT OF ViBW IN THE MEXICAN 

Republic. By Dr. Eduabdo Lici^aoa, Mexico 122 

Explanation of the Scientific Pbinciples, and the Data Acquibed 

THBOUOH EXPEBIENCE, ON WHICH THE OBDINANCES OF THE InTEB- 
NATIONAL MABITIME POLICE WEBE FOUNDED. By Dr. EdUABDO 

Lic^AOA, Mexico 137 

The Wateb-Supply of Chicago : Its Soubce and Sanitaby Aspects. 
By Abthub R. Reynolds, M. D., Commissioner of Health of Chicago, 
and Allen Hazbn, S. B., Chemist Water Department World^s Colum- 
bian Exposition 146 

On the Removal of Pathogenic Bactebia fbom Dbinkino Wateb by 
Sand Filtbation. By Geobge W. Fulleb, S. B., Biologist, Lawrence 
Experiment Station, State Board of Health of Massachusetts, Lawrence, 
Mass 162 

Pbophylactic and Thebapeutic Value of Food. By Ellen H. Rich- 

ABDS, M. S., Institute of Technology, Boston, Mass 161 

Municipal Hygiene and Sanitation. By E. S. Kelly, M. D., Com- 
missioner of Health, Minneapolis, Minn 169 

The Pbogbebs of Sanitaby Knowledge among the Women of England. 
By Lady Pbiestley, Vice-President of the National Health Society; 
Representative of Hygiene on the Woman's Committee of the Chicago 
Exhibition, London, Eng 172 

VOLUNTABY PUBLIC HEALTH AND SANITABY OBGANIZATIONB. By MisS 

Ada C. Sweet, Chicago, 111 176 

How Can Women Best Pbomote Public Sanitation? By Sabah H. 
Bbayton, M. D., Chairman of the Woman's Public Health Committee 
of the Congress Auxiliary 178 

Bbief Notice of the Climate and Diseases of Bbazil, Especially op 
THE City of Rio de Janeibo. By Dr. Julio Bbandao, Rio de Janeiro, 182 

Impobtance of Civil Public Hygiene to the State. By Sib Chables 
A. Camebon, Ex-President and Professor of Hygiene and Chemistry 
Royal College of Surgeons, Ireland, Chief Medical Officer of Health 
for Dublin 186 

Tubbbculosis and the Food Supply. By D. E. Salmon, D. V. M., Chief 
of the Bureau of Animal Industry, Washington, D. C 106 

Some Considebations About the Influence of Habitation in the De- 
velopment op Tubbbculosis. By Manuel Gutiebbez, Mexico, 
Mexico - 202 



TABLE OF CONTENTS. Vll 

Can SYPmT.TTio CoiirrAGioN Fobm the Vehicle fob the Tbaksmissioit op 
TuBBBCXTLOSis AS Well ? By Dr. Maihjel Cabmona y Valle, Di- 
rector of the National School of Medicine of Mexico, Professor of 
Internal Clinics, Member of the Academy of Medicine of Mexico, and 
Several Scientific Societies, Mexico, Mexico 204 

OvEBWOBK AND Unbest. By WiLLiAM Oldbight, M. A., M. D., Professor 
of Hygiene in the University of Toronto, Surgeon to St. Michael's Hos- 
pital, Lecturer on Hygiene, Ontario School of Pedagogy, Toronto, P. Q., 210 

Apunteb Sobbe la Escablatina en la Ciudad de Puebla, Mexico. 

Por el Dr. Fbancisco Mabin, Puebla, Mexico 216 

Los Ejeboicios Fisicos: La Higiene. Por el Dr. Edxtabdo R. Gabcia, 
Teniente Coroneldel Cuerpo de Sanidad Militar, Professor de Cirujia en 
laEscuelaPr^tica M^dico-Militar, Miembrode la Academiade Medicina 
y Delegado por el Estado de Tabasco a los Congresos de Washington, 
Roma, y Chicago, Mexico 218 

Los Cabbos Dobmitobios no Lleman las Condiciones que la Higiene 
ExiOE. Por el Dr. Febnanbo TXbbaga, Delegado del Estado de Do- 
rango Mexico, Mexico, Mexico 220 

La Gbipa, bus Fobmas t Cohplicaciones en Obizaba — su Pbofilaxia. 

Por el Dr. Gbegobio Mendizabal, Oriziba, Mexico .... 224 

Lab Aguas Potables de los Campos Pbesentan Muchos Peligbos. Por 
el Dr. Angel GayiITo, Professor Adjunto de Higiene y Gatedritico de 
Bacteriologia en la Escuela de Medicinia de Mexico, Mexico. ... 281 

The Obigin and Dissemination op Typhoid Feteb. By Prof. W. T. 
Sedgwick, Boston, Mass 236 

Municipal Sanitation. By Sabah Hackett Stevenson, M. D., Chicago, 242 

How Shall oub Lepebs be Cabed Fob? By Benjamin Lee, A. M., 
M. D., Ph. D., Secretary of the State Board of Health of Pennsylvania, 246 

El Tifo de Enebo de 1889 k Junio de 1893 en el Hospital Juabez. 
Por el Dr. Luis E. Ruiz, Catedr^tico de Higiene en la Escuela de Med- 
icinia de Mexico, Director del Hospital Juarez, Mexico, Mexico . . 253 

Algunas Reflexiones Acebca de la Infeccion y el Contagio del 
Tifo ExantemXtico. Por el Dr. Ram6n Icaza, Mexico, Mexico . . 258 

Pboceedings and Discussions at the Twenty-Fibst Annual Meeting . 261 

REPORTS OF COMMITTEES, ETC 

Repobt op the Intebnational Committee on Tellow-Pevbb ... 120 
Repobt of the Committee **on Sanitaby and Medical Sebvice on 
BoABD Emigbant Ships.*' By Medical Director Albebt L. Gihon, 

U. S. Navy, Chairman 14S 

Repobt of the Committee on the Pollution of Wateb-Supplies . . 191 
Repobt of the Committee on Restbiction and Pbevention of Tubeb- 

ouLOsis 208 

Repobt OF Tbeasubeb 295 

Repobt ON Necbology 297 



I. 

THE PRESIDENT'S ADDRESS. 

By SAMUEL H. DURGIN, M. D., 
Boston^ Mass, 

Mr. Chairman, Ladies and Gentlemen : As co-workers in the field 
of sanitary science, and its practical application to the prevention of dis- 
ease and death, we have assembled, from different parts of this and other 
countries, to join hands and to take counsel with each other. 

We have met this time under most unusual circumstances, and with 
surroundings and conditions of world-wide interest. 

The Columbian exposition marks an era in the world's history. Around 
us are gathered the evidences of advance in all lines of industry, of tal- 
ent, and of thought. There has been a peace congress, a congress of 
religion, a congress of charities and correction, and innumerable other 
gatherings, for the purpose of comparing notes and showing the great 
advance in our civilization in all lines of thought and endeavor. 

The American Public Health Association meets here to^iay under the 
temporary title of The International Congress of Public Health, in con- 
formity ¥dth its action taken at Kansas City two years ago, and in con- 
formity with other congresses held in connection with the World's Colum- 
bian exposition in this city. 

The great trust which this Association took upon itself twenty-one 
years ago has been worthily held, and the work to which it has addressed 
itself in the interest of humanity has been diligently pursued. It is fit- 
ting, perhaps, at this time, when we may be said to have attained our 
majority in years, to take a retrospective glance of public sanitation, and 
to note the possible results of its application in the relief of human dis- 
tress. The work of the sanitarian is manifold, and deals with the most 
vital of our personal and social interests. It deals with the air we 
breathe, the food we eat, the water we drink, the soil we live upon, and 
with the general welfare of mankind. It means the investigation of the 
rise, progress, and decline of epidemics, and a fostering growth of works 
and projects designed to prevent and remove the causes of disease. 

AIMS OF SANITARY SCIENCE. 

The sanitarian concerns himself but little with the cure of disease. 
The problem which he seeks to solve is how disease can be averted. The 
pathologist establishes the nature of morbid processes, and his investiga- 



2 THE PRESIDENTS ADDRESS. 

tions suggest to us the appropriate remedy. The aim of the sanitarian 
is to seek out and remove the cause or causes which produced these 
processes. It has been said that preventive medicine embraces every- 
thing which relates to the physical well-being of our fellow-men : so that it 
has to deal with all physical evils and, incidentally, many of a moral 
character. Its object is the health, and therefore the happiness and pros- 
perity, of man. 

It is sometimes objected that public hygiene cannot lay claim to the 
possession of the qualities of an exact science, that its data are too par- 
tial, its generalizations too sweeping. Unfortunately some reason for this 
feeling exists, on account of the enthusiasm of certain writers, who exag- 
gerate what is seen, guess at what is unseen, and shape their conclusions 
accordingly. 

True sanitary science, however, is built up slowly, by patient observa- 
ticm of facts. Sanitary science is not altogether of modem growth. It 
may be said to have experienced several revivals, but its real history is 
almost as ancient as history itself. 

HYGIENE AMONG THE ANCIENTS. 

ITie ancients fought against evil smells as vigorously as the modems. 
A process of disinfection was adopted by Ulysses, and described by 
Homer. Hercules, too, was a practical sanitarian ; but of all the ancient 
sanitary reformers, Moses was the most thorough and practical. He 
gave us the principle of the modem earth-closet, although the animals of the 
fiield may be said to have anticipated him in that device. During the biest 
times of Greece and Rome, public sanitation was much studied, and the 
supervision of hygienic arrangements was an office of dignity among the 
Greeks and the Romans. The cleansing and disinfection of streets and 
sewers were placed under a high officer of state, because, as Justinian 
tellis us, ''uncleansed and unrepaired sewers threaten a pestHential atmos- 
phere, and are dangerous." 

Sanitary science owes something to the fathers of medicine also. Hi)^ 
pocrates was the first sanitarian who wrote an entire book on public 
health, and his discourses on pure air, pure water, and pure soil ai^ 
instructive reading at the present day. It is exceedingly interesting and 
suggestive to find these ancient writers elucidating principles which the 
exact investigations of our time have demonstrated to be the tme founda- 
tion of sanitary science. 

In Mexico it has been shown that sanitary science must have reached 
a high degree of perfection in its history. Previous to the conquest of 
the country by the Spaniards, the towns were thoroughly and efficiently 
supplied with water by the most perfect system ; but the teachings of 
these early times were not permanently effective. The magnificent civil 
works were doomed to suffer ruin, and the world passed through dark 
ages of mental and physical barbarism. 



THE PRESIDEllTS ADDRESS. 3 

The devastating epidemics (rf the Middle Ages, which cut off one quarter 
of the population of Europe, are well known. Filth, instead of being 
abhorred, was almost sanctified. The monks imitated the filthy habits 
of the hermits and saints of early Christian times, and the early fathers 
commended them. Even St. Jerome used to praise the filthy habits of 
hermits, and especially commended an Egyptian hermit who combed his 
hair on Easter Sunday only, and never washed his clothes at all. Monks, 
up to the time of the Reformation, thought, or professed to think, that, by 
antithesis, pollution of the body indicated cleanliness of the soul. Prac- 
tically, indeed, it might be said to have helped to it, because the odor of 
-sanctity which infected these monks and hermits helped them to keep 
apart from the temptations of the world, for the world scarcely cared to 
come into too close contact with these odoriferous saints. 

MODERN SANITATION. 

The science of public sanitation, as practised in our day, is a growth of 
recent years, a reaction from the ignorance and negligence of previous 
generations in the matter of sanitary administration. This reaction may 
1>e said to have dated from 1838, when the English Poor Law Commis- 
sioners instituted an inquiry into the health of towns, with a view to 
remove by public authority some of the evils incident to poverty, for 
which the poor are not responsible and which they cannot themselves 
remedy. The active movers in this work were Dr. Southard Smith, Mr. 
Edwin Chadwick, Dr. Amott, and Dr. Farr ; and it is to their labors and 
testimony that much of the present enthusiasm concerning sanitary inves- 
tigation and administration is due. The work begun by these pioneers 
has been carried on with increasing zeal from that time forward. It has 
enlisted the active interest of a multitude of intelligent, earnest men, who 
have patiently and persistently devoted their energies to the investigation 
of the causes of disease, and a constantly increasing interest is being 
manifested 2»nong the people concerning all matters looking toward a 
more perfect conservation of the public health. 

Employers have found that there is a financial aspect to the sanitary 
questions of the day, and that more work and better work can be obtained 
isom men in health than from men diseased. 

Legislation has been influenced by the researches into the causes of 
disease, and has followed the lead of the investigators. 

The schools of Europe and America have one by one added to their 
requirements for a degree in medicine a knowledge of sanitary science. 
It is becoming more and more apparent, that the first and largest interest 
of the state lies in this great agency of human power, the health of the 
people. 

What practical results have followed from all this ? What has sanitary 
science done for man as an individual and for mankind collectively ? 

In the first place, it can be shown that man to-day has a greater expec- 



4 THE PRESIDENTS ADDRESS, 

tatioD of life than any of his progenitors. He may more reasonably took 
forward to a long life, and to a life less exposed to devastating sickness. 
His vitality has been expanded, his strength increased, and his days on 
earth prolonged. 

From this brief review of the general subject of sanitary science, let us- 
turn to a more specific and practical consideration of some of its princi- 
ples, and I will ask your attention for a few minutes to the topic o£' 
municipal sanitation, 

MUNICIPAL SANITATION. 

The municipal health officer, on entering upon his duties, finds himself 
confronted with innumerable questions as to the sources of danger to the 
public health, of which he has been selected as guardian. 

He first pictures to himself an ideal sanitary condition, for example : 
a clean, dry surface ; a well-drained soil ; good public and private sewer- 
age ; the immediate destruction or removal of all decomposable wastes ; 
wholesome food- and water-supplies, with a sufficient equipment to preserve 
all of these favorable conditions, and then his work of construction and 
maintenance begins. 

It would be impossible, within the scope reasonably given to a single 
address, to more than touch lightly upon the large number of topics, and 
the variety of each which falls under the care of the municipal health 
officer. I shall, therefore, delay you by a consideration of only a few of 
the more important subjects which affect the health of cities. 

WATER-SUPPLY. 

The difficulty of finding a pure and uncontaminated water-supply in 
sufficient quantity to meet the ever-increasing requirements of modem 
civilized life, has confronted every large city on the globe. With the 
increase of population, it is not possible to find a water-shed which is not 
more or less polluted by the wastes of human life. Our great lakes, even, 
at certain points upon their shores, have become at times sources of dis- 
ease. And some of the cities of the old world, recognizing the difficulty 
of procuring waters which are not contaminated by sewage, have, almost 
by force of necessity, adopted a suspicious supply, and have trusted to 
methods of filtration for the removal of the disease-producing elements. Lon- 
don and Berlin afford examples of the immunity from infectious diseases 
attending the use of waters so filtered. 

DRAINAGE. 

A variety of opinions is held among sanitary engineers, as to the best 

method for sewage disposal. The opportunity for the ultimate disposal of 

sewage is not the same for all cities. One city has the opportunity to dis- 

,i:harge its sewage into deep tide-water, under such conditions as to give 



THE PRESIDENT'S ADDRESS, S 

rise to no evil results ; while other cities are not so favorably situated. It 
would be a safe principle to follow, however, never to discHarge sewage 
matter into any river, lake, or body of water which is likely to be used as 
a source of water-supply, although I am not prepared to say that through 
the scientific experimentation now going on in the filtration of sewage- 
polluted waters, the time may not come when the waters of any river or 
lake may be used as a source of water-supply, and the sewage resulting 
therefrom then be returned to the streams in a state of comparative purity 
ivhich will render them available for domestic uses. However much we 
may disagree as to the ultimate disposal of sewage, there seems to be a 
general consensus of opinion that the water-carriage system must super- 
sede all others in its cheapness and capacity for a rapid and safe translation 
of our sewage from its initial starting-point to a proper and safe out-fall, 
where it may be disposed of without offence and danger to the inhabitants 
of the city. 

It is generally conceded, that when this material is confined within its 
proper channels, and constantly undergoes rapid removal, it is harmless, 
and does not deserve the opprobious epithet which it incurs under oppo- 
site conditions, namely, when stagnating without, or even within its 
-channels. 

Under these favorable conditions, the problem of the ventilation of 
sewers becomes extremely simple, by harmless open-grate covers over the 
manholes in the streets. The public sewers, thus supplied with the proper 
and continuous incline to secure the rapid and continuous flow, are ready 
to receive the private drainage from dwellings and factories and other 
sources. 

The construction of private or house drainage is more complex, and 
should be done only under regulations prepared by competent sanitary 
engineers, by plumbers who have shown their competency for such work 
to a proper board of examiners, and have been licensed therefor. The 
material for this work should be strong, tightly jointed, securely trapped, 
and ventilated above the top of the house. 

With a system of sewerage thus supplied, the privy-vault and cesspool, 
which have been most serious menaces to the health of cities, should cease 
to exist. 

It is easy to see that with such suitable provisions for the complete and 
rapid removal of all sewage, the escape of noxious emanations from the 
sewers into the streets and dwellings would be impossible. 

The conditions under which sewer gases are generated and penetrate 
into houses, are from the stagnation of sewage, when the generation of 
poisonous vapors is favored ; and the absence of sewer ventilation, in 
consequence of which these vapors are confined, until they acquire 
a sufficient degree of tension to force the barriers by which we vainly 
attempt to exclude them from our homes. By the rapid removal of sew- 
age, on the other hand, its putrefaction in our midst is forestalled, the 
generation of noxious gases within our drains and sewers is reduced to a 



6 THE PRESIDENT'S ADDRESS, 

• 
minimum, or wholly prevented. The ventilation of sewers is rendered easy 

and harmless, and finally, such air, gases, and vapors as must be contained 
within the sewers, being no longer confined, find an easy escape into the 
open air. 

In the city of Boston, our private drainage, like that in most cities, is 
unsatisfactory, and the cause of an immense amount of inspection, com- 
plaint, and annoyance, and undoubtedly the cause of much ill-health. We 
have statute laws and city ordinances which specify the method, material, 
and workmanship necessary for the construction of house drainage. Plana 
for construction and repairs are submitted to, and the work approved by, 
the inspector of buildings. 

The board of health is called upon to find defects and to order repairs, 
and such repairs each year number about 4,500. 

For the purpose of ascertaining to what extent defective conditions of 
plumbing exist, and to what extent traps are supplied, and water-closets 
substituted for privy vaults, we have taken a large number of blocks of 
dwellings, both new and old, each season for thirteen years, and made 

house-to-house inspections, with the following results : 

Per 

cent 

Want of traps first five years averaged . . .50 

During thirteen years 32 

During the last year 22 

Defective conditions of plumbing, first five years, averaged 49 

Whole thirteen years 39 

Diuing the last year 34 

Use of privy-vaults, first five years 28 

For thirteen years 14 

During the last year 3 

This means not only a very poor state of plumbing, but a want of com- 
mendable progress in the substitution of a better condition. It indicates 
poor construction and inefRcient repairs. 

It is my opinion that the regulations, supervision of construction, and 
repairs of plumbing should be in charge of one department. The old 
privy-vaults and cesspools, with their accumulation of filth, which were 
once so common, are now rapidly disappearing from the city. Nearly 
seven thousand of these privy-vaults have been demolished in as many 
years, and the few remaining, where a public sewer abuts the premises, are 
under orders to go. The yard cesspools, which are also common nuisances,, 
are being changed from receptacles for sink and other house drainage tQ» 
those for surface drainage only. 

The removal and disposal of refuse material has become a very serious 
question to the city as a corporation, and to the individual citizen. There 
are now in vogue several different methods for the disposal of the kitchen 
refuse, all of which are more or less objectionable. In one city it is car* 



THE PRESIDENT'S ADDRESS, 7 

lied away and dumped into the sea, in another it is collected and sold to 
the farmers, to be fed to swine, and in another it is removed to a distance 
from the city, and buried or consumed by fire. 

In the city of Boston, where the principal part is sold to farmers, and 
the remainder carried out to sea, the cost of collection and transportation 
has reached the annual sum of one hundred and seventy tfiousand dollars, 
or considerably more than the entire appropriation for the health depart- 
ment, which includes the maintenance of harbor quarantine, free public 
baths and urinals, hospitals for contagious diseases, disinfection, public 
vaccination, the care of public burial grounds, the inspection of nuisances, 
and other incidental expenses. This large cost cannot be diminished by 
any of the present methods in use, but must necessarily be increased by 
the growth of population, by hauling to a greater distance, or by the pro- 
cess of cremation, which is now in use in many of our cities. 

It must be admitted that the storing of this material in our yards, and 
its subsequent transportation through our streets, creates a nuisance of a 
most disgusting character, which, it seems to me, should not be looked upon 
by sanitarians as harmless, or the method of disposal as a satisfactory 
one, to say nothing of the enormous cost to the city. 

It has for many years seemed to me, that the kitchen wastes should, by 
some special provision in the kitchen stove, be disposed of as soon as they 
are formed. By this means, all subsequent nuisance and expense would 
be avoided. 

The other wastes of the city, which are now dumped into the har- 
bor, into other bodies of water, or upon vacant lots for filling, which are 
largely composed of combustible material, should undergo cremation, and 
their ashes be used for filling. 

STREETS. 

The construction and care of our public and private streets have a sani- 
tary side to be considered, especially when we remember the considerable 
proportion of the area of our cities which they occupy, and the frequent 
unsanitary condition in which we find them. While the construction of 
streets is almost purely a matter for the engineer, the health officer has 
frequent cause to complain of their filthy condition. Most streets in all 
cities present a more or less unclean and offensive surface. This condi- 
tion may be due to a faulty pavement, want of pavement, or a lack of 
care, which is supported by a popular notion that an unclean and muddy 
condition of the streets has no appreciable effect upon the public health. 
Macadamized streets, where much used, are unclean and offensive most 
of the time. 

It would be in the interest of public health, a cleaner atmosphere, greater 
public convenience and economy, if all the much used streets of our cities 
were paved with material which would present an even, durable, and non- 
absorbent surface. 



8 THE PRESIDENT'S ADDRESS. 

The private alleyways are not only disowned, but generally uncared for 
by the city. For the most part they are found to be unpaved, uncleaned, 
and a source of much complaint. Any attempt on the part of the health 
officer to cause these places to be cleansed by the abutters is attended with 
great difficulty, delay, and frequent disappointment. It would be far better 
to place these private ways in charge of the city, and tax the people for 
properly paving and keeping them clean. 

MORTALITY STATISTICS. 

Under the head of mortality statistics^ the health officer finds a valuable 
guide to important sanitary work, although it is to be regretted that much 
of the data found under this head is untrustworthy. These mortality 
tables, properly prepared, will show the extent of mortality, and to what 
degree it is excessive in any portion of the community, and its relationship 
to age and nationality. They will also show us the nature and causes of 
the diseases which occasion the excess of deaths, and to what extent and by 
what means these diseases are preventable. 

This work begins with the physician, and ends with the registrar of vital 
statistics. Many physicians perform the duty of certifying the cause of 
death with great care and exactness, while others perform the same service 
with very little knowledge of the disease of which the person died, and 
with corresponding ignorance of the use and value of correct mortality 
statistics. 

Unfortunately, in many states, no legal discrimination is made between 
the duties and privileges of the educated and the totally ignorant practi- 
tioner of medicine. The registrar who receives these certificates should 
be a well-educated physician, with considerable experience, so as to be able 
to reject fraudulent and worthless certificates. Every one who has had 
experience in the registration of mortality reports, understands how difficult 
it is to secure correct data from irresponsible persons. The cause of these 
shortcomings is partly insufficiency of diagnosis, due either to the difficul- 
ties inherent in obscure cases, or to imperfect medical training, and partly 
to a lack of conscientious regard for registration, whose objects and 
importance are not appreciated. 

Obscure cases will occur in the practice of every physician, and due 
allowance must be made, and yet, after reasonable allowances have been 
made, there still remains a degree of carelessness for which there is no 
excuse. 

It is a common thing to find on death certificates, instead of the morbid 
process which caused death, such indefinite information as " disease of 
bowels," "disease of brain," ''disease of skin," "stomach disease," 
"ascites," "convulsions," "dropsy," "fever," "debility," *• teething," 
"inflammation," "infantile," "heart failure," and other unlikely causes 
too numerous to mention, and which ought never to be used upon the 
records as causes of death. 



THE PRESIDENT'S ADDRESS. 9 

In my own city, such certificates are rejected, and a competent physician 
sent to view the remains, and consult the family or friends of the deceased 
for information with which to make a proper certificate. 

It is to be noted, however, that information gathered in this way cannot 
be regarded as wholly trustworthy, and often results in the statement of 
" unknown cause of death.*^ 

It would be in the interest of correct mortality statistics if the registrar 
could be authorized, in case of insufficient information, to cause such post- 
mortem examination by a competent medical officer as will enable him to 
record the true cause of death. 

An examination of the mortality statistics will also betray the fact that 
we have an excess of deaths from contagious diseases, and from diarrhoeal 
diseases among children, and while these facts open up a wide field of 
labor for the municipal sanitary officer, we shall have time to mention but 
a few of the most troublesome of these diseases. 

INFECTIOUS DISEASES. 

Small-pox, through the great discovery of Jenner, the ease of making an 
early diagnosis, and its perfect and easy control by isolation and disinfec- 
tion, is now one of the easiest and rarest, comparatively, of the contagious 
diseases with which we may have to deal. 

Now and then our legislatures are obliged to listen to the petitions of a 
few anti-vaccinationists for the repeal of compulsory vaccination laws. I 
have too much faith, however, in the intelligence and sound judgment of 
our people, to believe that these wholesome and necessary provisions will 
ever be effaced from our statute-books. 

We should not, however, in the absence of small-pox in our country, 
allow ourselves to grow indifferent to the necessity of keeping the suscep- 
tibility of our people to small-pox exhausted, by means of early and 
successful vaccination of infants, and the subsequent and most important 
re-vaccination of adults. 

The mention of cholera, like that of small-pox, strikes terror to the peo- 
ple of this country, and while the deaths from these diseases are infinitely 
small, the fear of them has served the municipal health officer in securing 
almost unlimited facilities for their prevention and control, which means 
may be largely converted to the care of other more common and destruc- 
tive contagious diseases. 

We have in diphtheria and scarlet-fever, diseases which are not only 
endemic in most of our cities and large towns, and of most difficult con- 
trol, but diseases for which there is as yet no known prophylactic. It is 
easy to say, and it is equally true, that perfect isolation and disinfection in 
all cases would soon annihilate the two diseases, but here is where the 
great difficulty begins. We do not know where the infection is, in a very 
large percentage of cases, and therefore cannot make anything like a com- 
plete application of our disinfecting agents. 



lO THE PRESIDENT'S ADDRESS 

The diagnosis of diphtheria and of scarlet-fever is not always possible 
in their early but contagious conditions, even by our best physicians, but 
with the multitude of ignorant and indifferent so-called practitioners of 
medicine, who are called to attend such cases, and the many instances of 
mild attacks which do not attract attention, to say nothing of the semi- 
popular prejudice against the hospitals, we have the causes of the lack of 
information to the sanitary officer, the possession of which might lead to 
the control of the diseases. 

These diseases are spread largely by children, while in the early stages 
of the illness or having mild and unsuspected attacks, and by those who 
are prematurely released from isolation through ignorance and fraud, and 
allowed in the streets and in our schools. 

It would be out of place, as well as presumptuous on my part, to delay 
you at this time with the details of necessary public interference, which 
would secure a mitigation of the prevalence of these two diseases. I will 
say, however, that I believe in early and continued hospital isolation, and 
that all cases should be supervised, and released from isolation only by 
medical officers appointed upon merit by the health authorities ; the same 
medical officers to be inspector^ of schools, in which there is much 
valuable work to be done in detecting the early symptoms of contagious 
diseases, pointing out the many unobserved and growing defects in de- 
velopment and disabled senses of the children, reporting to the board of 
health the overcrowded and unsanitary condition of the school-room, 
inspiring an interest and pride on the part of the teachers to develop an 
altitude in detecting early symptoms of disease, defective senses, and 
deformities in children, and in developing a»more popular interest in the 
needed reforms in school hygiene. 

At a very small cost, we might bring to bear the powerful influence and 
unoccupied energies of a large corps of talented young physicians, aided 
by over thirty-five thousand teachers, for the public and individual welfare 
of ne^ly thirteen millions of children in the public schools of the United 
States. 

Consumption^ the most destructive malady to the human race in our 
country, has received the necessary attention of the bacteriologist. He 
has demonstrated to us, satisfactorily, the cause of the disease, the meth- 
ods of its transmission, and the means for its prevention. 

I am sorry to say, that as practical workers in public sanitation we have 
sadly neglected to apply the means which we believe would prove effectual 
in largely abating the prevalence of tuberculosis. 

The isolation of all persons suffering from consumption, would be 
impracticable and perhaps unnecessary, but the use of small sputa cups 
containing a disinfectant, at home, and bits of absorbent napkin used and 
securely concealed in travelling, to be burned or otherwise disinfected on 
returning, should at least be urged by public health officers, and popular- 
ized as much as possible. 

In this way we should try to counteract the indiscriminate and dis- 



THE PRESIDENT'S ADDRESS. IT 

gusting habit of careless spitting in all public and private places, where 
the sputa are soon dried, and in the form of dust start on the mission of 
deadly infection. 

It is interesting in this connection to note the fact, that from experi- 
ments conducted with the tubercle bacilli, the sputa from consumptive 
patients have been found to retain their infective power for several years ? 
also the fact that at a recent international congress on tuberculosis, one 
of the questions discussed was the necessity of obligatory cremation of 
the remains of consumptives. 

Earth worms, it was urged, bring to the surface bacilli which infest the 
dead body, and in dry weather they may be inhaled in the form of dust. 
This, it is suggested, is the reason why the health resorts of the south of 
Europe are centers of tubercular contagion. 

Drs. Lortet and Depugnes of Lyons related cases of such infection, and 
described experiments which they made which led them to demand oblig- 
atory cremation. They mixed the sputa of consumptives in earth which 
they placed in pots. A month later the earth worms in them were tuber- 
cular, and the earth they passed through communicated the disease to 
animals. 

Other experiments were made by placing earth worms on the graves of 
those who had died of consumption, and it is said the results were con- 
firmatory of the possibility of contagion being conveyed in this manner. 

It should not be necessary to urge the sanitary claims of cremation for 
dead bodies before an assemblage of intelligent sanitarians. There are 
in this country already thirty-two cremation societies, fifteen crematories, 
and in the last five years there have been over two thousand incinera- 
tions. 

Typhoid fever, like cholera, has been studied most persistently and 
profitably in connection with our water and food-supplies, and we shall 
have the pleasure of listening to a discussion of the causation of typhoid 
by infect^ milk at this congress. 

HABITATIONS FOR THE POOR. 

Tenement and lodging houses are subjects for the constant watchfulness 
of the health officer, and they are too frequentiy found in an overcrowded 
and filthy condition. They are principally occupied by the poorest classes 
of people, including the newly arrived immigrant, whose habits of cleanli- 
ness are of the lowest order. 

It becomes necessary to limit the number of occupants in such build^ 
ings on a rule of a prescribed number of cubic feet of space to each indi- 
vidual, by placards posted in each room, compelling frequent scrubbing 
and disinfection of floors and walls, burning much of the old bedding,, 
frequentiy disinfecting the remainder by steam, watching them by night» 
and prosecuting every violation of your prescribed rules. 



12 THE PRESIDENT'S ADDRESS. 



CONCLUSION. 



Turning in conclusion from the more onerous every-day duties of the 
municipal health officer to topics of greater popular interest, we find an 
increasing growth of public sentiment in all parts of the country, favoring 
the municipal provision of large public parks, free public baths, small 
open spaces, and open-air g3rmnasiums for the enjoyment and sanitary 
welfare of the masses of people whose whole time is spent in the toil of 
our large towns and cities. Much of interest and encouragement might 
be said as to the immense patronage and benefit of these magnificent 
privileges if time would allow, but I pass over these and other important 
topics which I doubt not will receive that careful attention and discussion 
which their importance demands during the congress which is now open. 



II. 

VICErPRESIDENT'S ADDRESS. 

By dr. EDUARDO LICfiAGA, 

President of the Superior Board of Health of Mexico, 

Mexico, 

Mr. President, Ladies and Gentlemen : In the name of the dele- 
gates of the Republic of Mexico to the American Public Health Associa- 
tion, I have the honor to extend a friendly greeting to those hygienists 
of America who, after meeting in general congress in Canada and Mexico, 
have now met in the city of the World's Fair, in this grand and beautiful 
Chicago, Queen of the Lakes, to work together in a great, humanitarian 
cause, and render, at the same time, due homage to the illustrious man 
who has enriched mankind by the discovery of this immense continent 

As representatives of our country, we have come to return the visit you 
have paid us in Mexico, and to tell our friends that they have left grateful 
remembrances among Mexicans. . . We are now ready to follow our 
associates in the work of ameliorating the physical conditions of men, of 
improving public health, prolonging life, and contributing, by increased 
bodily health, to the improvement of the mind and to moral perfection. 
Moved by a common ambition, animated by the same love of truth, and 
by common aspirations, we have come to offer our cooperation, our con- 
tingent which, however humble it may be in itself, will acquire strength 
and influence when added to the valuable concourse of the United States, 
of Canada, and of those from the Old World who on this occasion have 
taken part in the scientific work of the American Public Health Associa- 
tion. 

Ladies and gentlemen, this Association has diffused in this great coun- 
try the principles of sanitary science. Among the many questions to be 
discussed here, we respectf uU/suggest that the proper method for simplify- 
ing the application of those principles be studied, so as to apply them as 
soon as possible, and to extend them to all towns and cities, large and 
small, rich and poor. The benefits of hygiene will really be great indeed 
when they will be extended to all, and for that purpose its rules should be 
laid down in a clear, practical, sensible manner, and they, should be of 
easy execution and not too costly. 

As long as the masses of people are not properly instructed in the 
principles of hygiene, municipal, state, or national authorities will be 
unable to take individual action. Their action, to be efficient, should be 



14 VICE-PRESIDENrS ADDRESS, 

uniform, and to obtain this uniformity the fundamental principles of sani- 
tary science should be explained in short, clear, and precise language ; 
this work of educating the people could be entrusted to an international 
committee composed of specialists in the different branches of hygiene. 
Their instructions should be published in English, Spanish, and French, 
and distributed in all countries and states represented in this Association. 

Members of the American Public Health Association, in the space of a 
few years you have achieved great results. Complete your mission by 
generalizing, by popularizing the application of your principles, and 
humanity will be forever indebted to you. 

Ladies and gentlemen, I greet you in the name of Mexico. 



III. 

ADDRESS OF WELCOMK 
By CHARLES C. BONNEY, Esq., 

PRXSIDKHT OP THE WORLD'S CONGRESS AUXILIARY OF THE WORLD'S COLUMBIAM 

Exposition, 
Chicago^ III, 

Ladies and Gentlemen, Friends of Public Health : As tlie 
general president of the World's congresses of 1893, 1 come to bid you 
welcome on this occasion. Through the committee of the World's 
congresses of the exposition season^ all societies of a given kind through 
out the world have been asked to unite in a World's Congress on a foot- 
ing of perfect equality. This rule of meeting on a basis of perfect equality 
has^ however, one exception. We have regarded it as a fitting privilege 
to allow American associations the honor of doing the principal woric, 
reserving high places of distinction, as far as possible, for those who may 
attend and participate in our work from foreign lands. Accordingly, in 
the organization of this Congress of Public Health, the American Public 
Health Association has taken a conspicuous part, acting in cooperation 
with the committee on organization of the World's Congress Auxiliary, of 
which Dr. John H. Ranch, of Chicago, so well known throughout the 
world as a representative of public health, is chairman, and the branch of 
the Woman's Congress Auxiliary, of which Dr. Sarah H. Brayton, di 
Evanston, Illinois, is chairman. 

I think we may congratulate ourselves at the outset, upon having such a 
large gathering here this morning, and I predict that this congress will be 
as great a success as any of the series of congresses that have been held 
thus far during this memorable year. The importance of this congress is 
so great that it cannot be over-estimated as the highest achievement in the 
science of education. It is not a college, but an enlightened people. As 
the highest achievement of the profession of law is not a law college or 
course for the enforcement of private rights, but an organized study and 
the actual administration of government ; so the highest achievement of 
medical science is not a medical college for eminent private practitioners, 
but is the actual organization of a department of public health, protected 
by law and supported by the public authorities. This movement for the 
organization of the public health as a department of government is, as you 
all know, of comparatively recent origin. The wonderful progress it has 
made during the last few years is one of the best evidences it can have. 



l6 ADDRESS OP^ WELCOME, 

This movement came at a time when there was a great demand for it. It 
came in answer to a great public need. The organization of a department 
of public health in government is the sole means of protecting the people 
against infectious diseases, bad water, bad food, inadequate drainage, and 
evils of like character, instead. of leaving, as in former generations, the 
great body of people a prey to all these great and serious evils. State 
boards of health protect tlie people against these enemies, as well as 
against the invasion of other foreign foes. The obstacles which this new 
movement of public health has met in the endeavor to serve the public 
weal, has not been slight or easily overcome. There was first the intense 
public prejudice against the invasion or demand, as it was called, of 
private rights and privileges. There was an intense and bitter hostility to 
private interests, and it was said that public health officers sought to 
thrive on the ills of mankind instead of proving blessings to their fellow- 
men, hence there was official apathy, want of interest involved in this new 
movement. Indirectly, public officials saw another obstacle hard to over- 
come, but the greatest of all obstacles with which the movement in favor 
of public health has had to contend with, — the very greatest, I think I am 
warranted in saying, — ^is ignorance of the nature, extent, and rights of the 
executive power. In all constitutional governments, the powers of govern- 
ment naturally divide themselves into three great departments, — those of 
the executive, the judicial, and the legislative power. In the Americao 
states and in other constitutional countries, it is scarcely too much to say 
that the importance of the legislative power has been greatly exaggerated, 
and the demands upon it have been in excess of the real nature. The 
, common masses of this country, and I presume to some extent of other 
countries, as witnessed by representatives here, when any serious evil is 
presented to the public, rush to the council or legislative body for a new 
enactment against it. If the enactment be not accepted and obeyed, then 
follows a long and tedious course of litigation, until all the questions that 
can be raised by the ingenuity of lawyers or judges shall have been dis- 
cussed and finally settled. All the powers of government which are not 
legislative and judicial, are entrusted to executive hands, and when an 
evil arises and needs to be met, the public officers of the executive, the 
mayors, governors, etc., are not authorized or warranted, by the funda- 
mental law of constitutional governments, to interfere until some legislative 
enactments have been obtained and some litigation shall have been 
carried through. The true inquiry in such cases is not, what authority 
has the executive power to do with these evils ; but the true question is 
whether any insuperable obstacle exists to immediate action for the pro- 
tection of the public interests. Thus the maxim, ^^ Salus populi est 
suprenux^^ is the fundamental principle of constitutional government. I 
do not hesitate to say, after having had occasion to examine this subject 
at some length, that if we have in this and other countries one year of 
efficient executive administration of real government, protecting the people 
in conformity with their constitutional rights of protection, it would pro- 



ADDRESS OF WELCOME, 1 7 

duce greater benefits in the way of actual results, and would be more 
acceptable to the public mind, than anything to which we can point our 
fingers in the last three or four or half dozen decades. [Applause]. This 
congress may do much toward the removal of all obstacles to which I have 
called attention. The supreme object is the creation of that public opinion 
which is master alike of presidents, kings, and emperors, — that irresistible 
power of public opinion to which all governments must respond, for when 
the public opinion of any country demands a measure for the protection 
of its people, that measure will not be long before it is carried out. 
When Xht public mind is educated to demand certain things for the pro- 
tection of the people against the inroads of evils and plagues, they will 
have them. It is a matter of time. 

I bid you a hearty welcome, and wish you the utmost success in all 
your deliberations, trusting that the papers to be read here will represent 
the best thought of the world on the topics to be discussed. 

We bad hoped to have with us on this occasion Mrs. Potter Palmer, 
representing the women's interest in all these subjects, but we have with 
us the acting president of the woman's branch of the World's Congress 
Auxiliary, Mrs. Charles Henrotin, who will now address you. 



IV. 

REMARKS. 

By Mrs. CHARLES HENROTIN, 
Vice-President Woman's Branch of the World's Congress Auxiliary, 

Chicago, IlL 

Mr. President, Ladies and Gentlemen : I think, for the first time in 
my life, I come before you as a pessimist. I have felt very much the 
courtesy of the committee in forming a committee of the women in 
connection with this congress. In view of the criminal indifference 
and negligence of women in matters of sanitation and public health, 
I think their forbearance and courtesy are to be praised. It is a strange 
thing that American women, so anxious and so endowed as they are 
with most questions of public interest, should apparently be so very 
indifferent to this one. During the organization of the congresses, I hap- 
pened to be travelling on a railroad fronting most of the back 3rards, or 
rather passing through most of the back yards, of the country, through 
western New York and other states. I thought to myself, that if the chol- 
era comes to the exposition this year, we will owe it to the back )rards of 
the villages and most of the small towns of the country. It would seem 
as if the women had made special effort to dump everything unsanitary, 
disagreeable, and unsightly along the lines of the railroads and in the 
alleys. I do not know what the cause of this can be ; but there is abso- 
lutely great indifference among women on this subject, which I think you 
will not be able to correct until you have a few on the boards of the public 
health. [Applause.] It may be, that when they are better informed, and 
have correct information on the subject, from women, it will arouse their 
interest. There is a little awakening of light throughout the country, as 
you may see by the formation of the New York Health Protective Asso- 
ciation, which has done such excellent work in connection with the abat- 
toirs of New York ; also in Chicago, by the Municipal Order League. I 
shall not speak on that point at this time. Dr. Stevenson, who has been 
so interested in it, is here, and will present its work to you. Dr. Brayton, 
chairman of the committee, tells me, that while attending the Sanitary 
Health Congress in London, last year, there were 200 women in an audience 
of about 1,000, and 20 women speakers, who spoke on the subject of 
public health. At this Congress we shall be able to offer you a paper 
written by an English woman. I hope by the next time when you come 
to Chicago, that we shall be able to show a good average with our English 
sisters in taking an active part in your work. [Applause.] 



V. 

REMARKS. 

By Dr. A. R. REYNOLDS, Commissioner of Health, 
Chicago^ HI, 

Mr. Chairman, Members of the American Public Health Asso- 
ciation : I was greatly pained this morning, when I telephoned the mayor 
of his engagement to be here, to learn that the labors of yesterday, in 
connection with the celebration at the Fair grounds, had rendered him 
quite indisposed. He instructed me, however, to express to you his regret 
in not being here, and to extend to you in his behalf the freedom of the 
city and a cordial welcome. He instructed me further to say, that he 
hoped your deliberations would be of great profit to yourselves and of 
great good to the public at large. [Applause.] 



VI. 

REMARKS. 

By Dr. SARAH HACKETT STEVENSON, 
Chicago^ III. 

Ladies and Gentlemen of the American Public Health Asso- 
ciation : It gives me great pleasure to welcome you to Chicago. It was 
a great surprise to be asked to say a word this morning. I think Mrs. 
Henrotin has put a great deal of responsibility upon the public health 
associations. A great many of the ills of mankind are due to individual 
filthiness. The people themselves require a public health police officer 
stationed by the side of each one of them. It is individual filthiness 
that makes the public accumulations of filth that we are trying to dispose 
of, and it is almost impossible for any association or set of individuals to 
try to rectify this great defect. The teaching of sanitation in the homes 
of people seems to me to be the most important thing we need, above and 
beyond everything else; because, if individuals are slovenly about these 
matters, it is impossible for any mayor, any public health association, any 
public health officer, to dispose of the unsightly and unsanitary things that 
accumulate in our cities and villages. If anything shall come from this 
Association whereby we can get at the education of the individual in 
personal habits of cleanliness, then we shall not have spent our time in 
vain. We cannot station a superintendent by the side of each individual 
in our great cities. We have in this city one million five hundred thousand 
people, and each one contributes so much to the common mass of filth ; 
and until every individual can be taught the laws of hygiene and habits of 
personal cleanliness, I cannot see any way out of this great difficulty. 

We are very glad indeed to see so many of you this morning, and we 
bid you a cordial welcome. 



VII. 

AN EXPERIMENT IN DISINFECTION.— HOW AN EPIDEMIC 
OF PNEUMONIA WAS CHECKED. 

By JEROME COCHRAN, M. D., 

Health Officer of the State of Alabama, 

MobUe, Ala, 

For the past twenty years, ever since the epoch-making treatise by 
Juergensen in Ziemson's cyclopaedia, pneumonia has been more or less 
generally regarded as an infectious disease, due to a specific germ. But, 
so far as I have been able to ascertain, no effort has heretofore been 
made to check its dissemination by disinfection. Perhaps the reason of 
this is, that this disease ordinarily occurs only in scattered cases, rarely 
presenting itself in a grave epidemic form, so that resort to preventive 
measures has not often seemed to be urgently indicated. Epidemic out- 
breaks have, however, been occasionally described, especially as occurring 
in prisons. A very fatal outbreak occurred a few years ago in the Ken- 
tucky penitentiary; and in 1888 there was a similar outbreak at the old 
Shaft prison at Pratt Mines, inhabited by Alabama convicts. 

During the present year, 1893, another outbreak, which is the subjpct 
of this sketch, occurred at Pratt Mines. It was confined to Prison No. 2, 
which had a prison population of about 600. At Prison No. i, about a 
mile away, with about the same prison population, and with the same 
general management, there was not a single case. At Pratt City, about 
two miles away, with a population of about 2,000, there was not a single 
case. There were also several family residences scattered about in the 
neighborhood of the prison, which escaped without a single case. Even 
the officers and guards of the prison who did not sleep in the prison 
wards, escaped without a single case. In one ward the epidemic was 
strictly confined to the convicts who slept in Prison No. 2. It was evi- 
dently not due to unsanitary influences of the general environment. The 
prison is a good one, well built, well ventilated, well lighted, and admi- 
rably policed. 

These facts suggested the conclusion that the epidemic was caused by 
a strictly localized infection, that had in some way been brought into the 
prison ; and this conclusion suggested the hope that the disease might be 
amenable to the influence of disinfection, and the aid of disinfection was 
accordingly invoked. 



22 AN EXPERIMENT IN DISINFECTION. 

The pneumonia made its first appearance in the prison in February, 
with three cases. In March there were three cases. In April there were 
twenty-two cases. In May the cases ran up to a total of sixty-five, as fol- 
lows : The first week in May, fourteen cases ; the second week, thirty-one 
cases ; the third week, thirteen cases ; the remainder of the month, seven 
cases, ending the epidemic. Total number of cases during the epidemic^ 
innety-three. Total number of deaths, thirty, nearly one third of the cases. 
This expresses only the primary mortality. After apparent convalescence, 
several of the cases lapsed into some chronic ailment and finally died, so 
that the ultimate mortality was more than one third of the cases. 

Concurrently with the outbreak of pneumonia, and strictly confined to 
the same prison, there was an outbreak of a much milder malady, entirely 
without pneumonic S3nnptoms, which the prison physicians, for want of a 
better name, called grippe, although it did not present the characteristic 
symptoms of any of the recognized varieties of that Proteus of disease. 
Some of these grippe cases developed into the prevailing pneumonia. 
Many of them were not of much severity, but twenty-five were severe 
enough to be admitted to the hospital. This disease disappeared when 
the pneumonia did. I was, myself, satisfied that it was due to the same 
cause that produced the pneumonia, and in this opinion I was sustained 
by Dr. Charles Whelan and Dr. K P. Riggs, distinguished physicians of 
Birmingham, who were called to assist me in the diagnosis. 

The disinfection was begun on the 14th day of May, the last day of the 
second week, on which day there were six new cases, and just when the 
epidemic had reached its greatest prevalence, and was finished in six 
days for that part of the prison in which the convicts slept. The hos- 
pital, a detached building, was disinfected on the 2d of June, and the 
school-room, which, on account of the unusual amount of sickness, was 
used as a temporary hospital, was not disinfected until the 21st of June, 
long after the epidemic had ceased to spread. 

After the six days consumed in the disinfection of the prison proper, 
only seven new cases developed. The period of incubation in pneumonia 
is not known ; but it seems fair to conclude that these seven cases received 
the pneumonic infection before the disinfection of the prison was fin- 
ished. 

The plan of disinfection was simple, but was carried out as thoroughly 
as possible. The prison consisted of three sections. While the disinfec- 
tion was going on in- one section, the convicts belonging to that section 
were crowded into two other sections. The mattresses were taken off 
the bunks and stripped of the mattress cases, and these, together with the 
blankets, were scattered over the floor. Then, by means of a force-pump 
and a long hose-pipe, the ceilings, the walls, and the floors with their con- 
tents were deluged with a solution of bichloride of mercury, one to the 
thousand, until it stood in puddles and ran in rivulets on the floors. The 
mattresses, blankets, etc., were turned over, so as to be wetted on both 
sides as thoroughly as possible. If I could have been assured that the 



AN EXPERIMENT IN DISINFECTION 23 

mattresses were wetted through and through by this process, I might not 
have thought it necessary to resort to other means of disinfection ; but as 
they were half cotton, I could not count on the thorough penetration of 
the disinfecting fluid. Besides, I have more confidence in the disinfect- 
ing power of heat than I have in the disinfecting power of bichloride. 

The mattresses, blankets, etc., were therefore put into large steam 
chambers, which had been constructed for the purpose, and steamed for 
six hours, after which they were taken out and dried. In the meantime 
the disinfected wards were thoroughly scrubbed out and whitewashed, 
and fitted up so that they could be occupied the next day. The convicts, 
before they were returned to their old quarters, were required to take a 
bath and put on clean clothes. 

It is necessary to state that my suspicions were vehemently directed 
against the mattresses, and I was specially anxious that they should be 
disinfected with the utmost thoroughness. It will not do to place too 
much confidence in the apparent results of a single experiment, but in 
this case the facts are sufficiently remarkable. In one short week a 
malignant epidemic, assaulted at the period of its greatest prevalence and 
most rapid increase, went out like a fire under a deluge of water. 

The character of the cases in this epidemic deserves description. The 
prodromata were not marked. The outset was sudden and very severe. 
The circulation at the beginning of the attack was greatly obstructed, the 
pulse at the wrist being hardly, and sometimes not at all, perceptible. 
Subsequently, under the use of stimulants, the pulse to some extent 
revived, but remained feeble, and soon became very rapid. The tem- 
perature in the majority of the cases was from 103° to 104° Farenheit, 
but in some cases reached 105° and 106°, and in one case rose to 107°. 
The feeling of prostration and debility was intense. The physical ^yvsx?' 
toms of croupous pneumonia were not well developed. Crepitant riles 
were absent. There was very little cough, and very little of the charac- 
teristic red expectoration. As we have seen, the mortality was very high. 
The post-mortem appearances were quite remarkable, and a post-mortem 
examination was made in every fatal case. In most of the fatal cases 
both lungs were involved. The consolidation often began in the central 
parts of the diseased lungs, and gradually extended to the surface, so that 
a slice from the surface would easily float in water, while a slice deeper 
down would sink like lead. The most remarkable characteristic, however, 
in the pathology of the disease, was the universal presence, in the fatal 
cases, of ante-mortem heart-clots. These were found in both sides of the 
heart, although most fully developed, perhaps, in the right side. They 
extended from the cardiac chambers into the larger arteries, — aorta, pul- 
monary, etc. — sometimes to a distance of several inches. There was no 
question that the heart-clots were ante-mortem. They were firm, white, 
organized into layers, and quite tough — the largest and firmest heart-clots 
I have ever seen. Strange to say, the presence of these immense clots 
gave rise to no distinctive physical symptoms. 



24 AN EXPERIMENT IN DISINFECTION 

Apropos of heart-clots, Osier, one of the latest authorities, states that 
heart-clots are very rare in pneumonia. 

In the presence of such a complication, all treatment was utterly ineffi- 
cient. 

Of course the question may be raised whether this was an outbreak of 
croupous pneumonia of malignant type, or whether it was a distinct cardiac 
and pulmonary malady. 



VIII. 
NOTES ON CHOLERA, AND ITS MANAGEMENT IN HULL. 

By JOHN WRIGHT MASON, M. B. C. M., D. P. H. (Aberd.), M. R. C. S.. 

Eng. Medical Officee of Health ; Surgeon Hull Borough Police Force ; 

Medical Superintendent, Hull Sanitarium, Medical Officer of 

Health, Hull & Coole Port Sanitary Authority, 

HyUy England. 

The foundation of the town has been generally ascribed to Edward I, 
in 1296, but its existence as a town and port has been proved to be more 
than a century older than that period. 

However, in 1299 Hull had its first charter granted, and then became a 
free borough. 

The population, according to the census in 189 1, was 200,934, equal to 
25.4 persons per acre. 

The rate of increase from the last census was 20.7, the average increase 
for the twenty-eight largest towns in England being 11.2 per cent. 

The town and county of Hull is the third port in Great Britain, and has 
at present an estimated population of over 208,000 inhabitants, and an area, 
in acres, of 7,901, and through its extensive shipping, having communication 
with all parts of the civilized world. 

The whole of the soil of the flat around Hull is of alluvial clay or warp 
of more recent deposits. This deposit varies from four feet to ten feet 
in thickness, imposed upon layers of silt, sand, or gravel, the whole of 
which is incumbent on the chalk formation, which varies from forty feet to 
one hundred and ten feet from the surface, and rises in high levels and 
hills to the north and north-west. 

The area of the borough itself, if we except the variations caused by 
artificial works, is perfectly flat ; from this cause, and from the lowness of 
the ground-level, natural drainage would be impossible were it not for the 
ebb and flow of the tide in the rivers Hull and Humber, by which a fall of 
ten to fifteen feet is obtained for several hours daily. Hull has been vis- 
ited by cholera on several previous occasions, and history bears testimony 
to its ravages. 

The first epidemic occurred in 1832, but the total number of deaths 
from the disease did not exceed two hundred and seventy. 

On the tenth of August, 1849, ^^^ great visitation of the disease com- 
menced. The total number of cholera and diarrhoea victims during the 
invasion was 1,860, being one in forty-three of the whole population of 
81,000. Six hundred persons died from cholera in one week in September. 



26 NOTES ON CHOLERA, 

The average age of the victims was thirty to thirty-five years. Of the 
total number of deaths recorded, 1,738 belonged to the laboring class and 
122 to the wealthy. 

The greatest mortality occurred in those parts of the town where the 
levels were the lowest, and in which the unsanitary surroundings were the 
most noticeable. 

It is recorded by an eminent minister, that in one day, Black Sunday, 
he himself interred no less than forty-three bodies of his fellow-citizens. The 
water-supply was, at that time, obtained from the Stoneferry water-works, 
situated one and a half miles from Hull and two and a half miles from the 
mouth of the river, the water being obtained from the river Hull, the wide- 
spread character of the epidemic being greatly attributed to the impurity 
of the river water. 

Since 1849 ^^ ^^s increased both in wealth and population, and its 
area has been considerably extended. 

The corporation have expended vast sums in establishing a pure water- 
supply, obtained from chalk borings at Springhead and Cottingham, situated 
some five miles distant from the borough, giving an average daily supply 
of forty-six gallons per head of the population ; and of which the following 
is an analysis, by the borough analyst (James Bayne, F. I. C.) : 

Mason on Cholera, in Hull 3. 

Grains per gallon, — ^Total solid residue, 19.8 ; Chlorine, 1.3 1. 

Parts per 1,000,000, — Free ammonia, .024; Alb. ammonia, .02. 

Extensive drainage operations, with auxiliary steam power, have been 
carried into effect, and further extensions are now under consideration, in 
order to render the system complete. 

New building regulations, upon the model of the local government board, 
have been put in force. 

Hospitals, both land and floating, have been provided for the reception 
of cases of infectious disease, with disinfecting stations and wards for the 
isolation of suspicious cases, together with accommodation for families re- 
moved from houses in which cases of infectious diseases have occurred, 
and which does not admit of the house being properly disinfected while 
they remain therein. 

Public baths, destructors, and mortuaries have also been erected in 
various parts of the borough. 

There are three public parks, affording recreation for the people, com- 
prising an aggregate of 107 acres of land. 

The docks extend over an area exceeding 186 acres and having five en- 
trances. 

The number of emigrants passing through the port, en route to America, 
has averaged between 50,000 and 60,000 yearly during the past ten years. 

The infectious diseases (notification) act, 1889, has been applied to the 
port as well as to the urban authority. Measles was included amongst 
the notifiable diseases on February 10, 1893. 

Cholera follows the line of international communication, and with the 



NOTES ON CHOLERA, 2*J 

modem increased facilities for rapidity of transit, so is the danger of its 
possible invasion increased by emigration, or otherwise. 

Our ports are the gateways to our industrial and manufacturing centres, 
and they have not only to jealously guard their own commercial interests, 
but the health and welfare of the country generally. 

England does not depend upon the false security of quarantine, but 
rather upon its sanitary administration, and each district should be in such 
a state of sanitary preparedness that the disease, if imported, should not 
spread. 

The experience of 1892, during the epidemic at Hamburg, in those ports 
which were exposed, and possibly none more so than the port of Hull — 
which was in daily communication with that cholera-stricken city, must 
have inspired confidence, in the public mind in this country and the con- 
tinent of Europe, that medical inspection, the due regard to the rigorous 
inspection of all articles likely to convey infection, improved sanitation, 
and efficient hospital equipment were alone sufficient to arrest the progress 
of the disease. 

Our natural defences against the introduction of cholera depend upon 
our first and second lines of defence. 

Our first line of defence consists of the medical inspection, upon arrival, 
both by day and night, of all vessels from cholera-infected or suspected 
ports, and should cholera have developed during the voyage amongst any 
of the passengers or crew, the removal of the patients to the hospital, and 
the isolation of suspected cases, and the detention on board the vessel of 
such persons who may be in a filthy or otherwise unwholesome condition, 
and who cannot satisfy the medical officer of health as to their place of 
destination. 

Healthy persons are allowed to land, subject to the notification of their 
place of destination, the vessel only being detained for purposes of 
disinfection under the directions of the medical officer of health, or in 
case a patient is in too dangerous a condition to be removed to hospital. 
The- drinking-water, if taken in at any infected port, is ordered to be thrown 
overboard and the tanks cleaned, upon a proper supply being furnished 
in lieu thereof, by the authority, and the bilges pumped out and thoroughly 
disinfected, before the vessel is allowed to enter the dock. 

The local government board have made regulations, from time to time, 
for carrying into effect the above recommendations. 

These duties, imposed by the local government board, I need not add, 
have been faithfully carried out by the port sanitary authority. 

Last year, during the prevalence of cholera at Hamburg, two cases of 
cholera were detected on board vessels arriving from that cholera-stricken 
city, one of which died in hospital and eight other persons, who had 
suffered from slight diarrhcea during the vojrage from other cholera- 
infected ports, were detained in hospital for observation. 

The second line of defence against the possible introduction of cholera, 
or other diseases, should be well protected, and the early preparations 



28 NOTES ON CHOLERA, 

against the means by which such diseases, if imported, spread, should be 
studied, thought out, and perfected in the interim, and not during epidemic 
prevalence and excitement. 

Special attention should be directed towards a pure and unpolluted 
water-supply, the periodical and regular removal of all excreta and refuse 
matters in the midst of populations, the frequent flushing of all drains 
and sewers, the prevention of over-crowding, the systematic inspection 
of common lodging houses, and lastly, but not least, our food-supplies. 

Upon the receipt of a notification of choleraic diarrhoea or typhoid 
fever, covered sanitary pails are provided, containing disinfectants, for 
the reception of the excreta of such patients, and are removed daily, the 
contents thereof being submitted to cremation. 

Hull is essentially a privy town. The collection is carried out by con- 
tract weekly, and in some of the more populous courts bi-weekly ; disin- 
fectants being freely distributed during the process of collection. 

The corporation have now under their consideration, a scheme to carry 
out this important branch of the public health administration themselves. 

When the public can appreciate that the retention of house refuse any- 
where near a dwelling is a source of danger, they will insist upon its 
daily, or more frequent, removal. 

The death-rate of Hull from all causes, for the ten years, 1882 to 189 1, 
averaged 20.7 per 1,000. 

The death-rate from fevers during the same period was equal to 1.26 
per 1,000, and for diarrhoea alone i.io per 1,000. 

Hull has long been recognized as a town in which autumnal diarrhoea 
is prevalent. 

The death-rate from diarrhoea is a great factor in the general average 
mortality for the year. 

I will now deal more particularly with the subject-matter of my paper, 
m., the management of cholera. 

Early in July an increased diarrhoea mortality occurred, and the follow- 
ing tabulated statement shows the number of deaths from diarrhoea, at 
various age periods, in fortnights, according to the returns furnished by 
the various registrars of death, together with those from typhoid fever: 



NOTES ON CHOLERA, 
DEATHS FROM DIARRHOEA, BY AGES. 



29 



FoKTNiGHT Ending. 


1 

c 
t3 







2 


5 




>2 




73 


July X 


13 

t 

57 
40 










I 
I 
4 

5' 

7 
2 


I 
I 


14 
44 


"15 


2 

3 

23 
10 


I 


I 

I 


2 

I 
2 
I 


*" 


Aoff. 12 


« 26.::.:.:::.:::::::::::: 


S3 


September 9 






•« Z'l 






•0 • 








343 


53 


I 


2 


6 


20 


2 


427 



DEATHS FROM TYPHOID FEVER, BY AGES. 



FoKTNiGBT Ending. 


■1 


^ 
S 




.0 





S 


4 

1 


1 


InlT I 
















I 


^«^iS 




I 










2 


" 29.::::.;..::::::::::::: 














Ansnst 12 






3 

2 










3 


Angosi 12 .............. .. 






2 

4 
4 








September 9 










" 21. 






2 






13 
















I 


7 


10 


14 






32 









No introduction of Asiatic cholera had occurred, to the knowledge of 
the sanitary officials, but possibly, with the excessive high temperature and 
prolonged drought (higher than in any period during the last half century), 
diarrhoea had been more generally fatal, amongst the very young and 
feeble, than had generally been experienced during the autiunnal quarter^ 
and cases of choleraic diarrhcea had been recorded. 

The increased mortality I believed to be due to the exceptionally high 
temperature and prolonged exposure (especially exercise during excessive 
heat), and secondly, to the greatly increased decomposition of articles of 
food, and possibly their storage in improper places. 

The precautions instituted by the sanitary authority last year, for the 
second line of defence against the introduction of cholera, have been 
uninterruptedly carried out, with further additions, and are as follows, viz.x 

1. A letter has been addressed to the medical practitioners in the 
borough, requesting them to notify all cases of choleraic diarrhcea to the 
medical officer of health, on the usual notification form, and for which the 
fee will be paid. 

2. A supply of diarrhoea mixture has been forwarded to the various 
branch police and fire-escape stations, for gratuitous distribution. 



30 NOTES ON CHOLERA. 

3. A supply of disinfectants has also been established at the various 
branch police and fire-escape stations and sanitary department for distribu- 
tion, and the whole of the medical practitioners have been supplied with 
orders to provide disinfectants wherever they may deem necessary. 

4. Complete hospital accommodation has been provided for the reception 
of patients, and a reserve of beds and tents has been held in readiness. 

5. Ambulance arrangements have been provided for the immediate 
removal of patients, and a reserve in readiness if required. 

6. The sanitary offices are kept open day and night, and telephonic 
communication has been established between the residence of the medical 
officer of health, the hospitals, and various branch police and fire-escape 
stations, where messages may be received. 

7. All cases of deaths from cholera occurring in private houses, are 
removed to the mortuaries especially erected in the various cemeteries, and 
the bodies are interred in an isolated portion of the ground, under the 
direction of the medical officer of health ; the assistant inspector for the 
district carrying out the various details, the sanitary officers acting as 
bearers, every sanitary precaution being adopted. 

8. The cholera sub-committee, especially appointed, meet daily at noon, 
to receive the reports of the medical officer of health, and are empowered 
by the town council to take every precaution they may deem necessary in 
the interests of the public health, irrespective of cost. 

Since the twenty-fourth of August we have had twelve deaths from 
cholera, and the following cases have been notified by the medical prac- 
titioners, viz,\ cholera 12, choleraic diarrhoea 125, and diarrhoea 329. 

The earliest suspected case, thanks to the medical practitioner called 
in attendance, a member of our sanitary committee and corporation, was 
immediately investigated. 

It was that of a school-boy, aged eleven years. He, attended school on 
the twenty-third of August, and was quite well on the evening of that 
date, when the family retired to bed. 

He had partaken of the ordinary food common to the family, all of 
whom, at the time of my investigation, were in the enjoyment of good health. 

He had not had any connection with either the shipping or the docks. 

He sickened at 5:30 a. m. on the morning of the twenty-fourth, and 
died about 2 p. m. the same day. 

The body was immediately removed to the mortuary, and the usual 
sanitary precautions carried out. 

I was present at the post-mortem examination upon the body of the 
deceased, and portions o£ the viscera were submitted to Dr. Klein for 
microscopical and bacteriological examination and report thereon. 

Dr. Klein, after due investigation, certified that in his opinion the case 
was one of Asiatic cholera. 

The second case was that of a widow, aged 55 years, who sickened at 
I a. m. on the morning of September i, and died at 11:20 a. m. the 
same day. 



NOTES ON CHOLERA, 



31 



The body was forthwith removed to the mortuary, and I performed a 
post-mortem examination, and again forwarded a portion of the viscera 
to Dr. Klein for bacteriological examination. 

Dr. Klein also certified the cause of death to be due to cholera. 

I would note, that from personal investigation of these cases, the 
patients were attacked early in the morning, when the vitality is at its 
lowest 

They awoke suddenly, seized with diarrhoea, vomiting, and cramps in 
the body, arms, and legs, followed by extreme prostration, husky voice, 
fingers contracted, and coldness and blueness of the extremities, accom- 
panied by rice-water stools. In some three cases, in which death 
rapidly took place, the symptoms were characterized by cramps, extreme 
prostration, and but little purging (rice-water). 

The bodies underwent rapid decomposition after death. 

There has been no spread of the disease from the original centres, and 
in three instances only were there secondary attacks in the same house, 
as will be seen by referring to one of the foregoing tables. 

Every possible inquiry has been instituted, but as yet no evidence has 
been adduced as to how the disease was imported, but it may possibly 
be due to a recrudescence of last year, from mild cases that may have 
escaped and not been recognized. 

The following table shows the number of deaths that have occurred 
from cholera, with the date of death, sex, age, occupation, and address of 
the deceased persons : 







DEATHS FROM CHOLERA. 


Date of 
Deaths, 1893. 


Sex. 


1 


Occupation. 


Address. 


August 24 . . . 


Male... 


II 


Schoolboy... 


6 Havelock Terrace, Dansom Lane. 


September 2 . . . 


Female. 


SS 


Widow 


3 Amelia Place, Starch House Lane. 


3-- 


Female. 


19 


Factory hand. 
Victualler.. . . 


« <« «< 


3t.- 


Male. . . 


6S 


Queen's Road. 


4*.. 
6».. 


Male. . . 


44 


Laborer 


I Tames Place, Windsor Street. 


Male... 


6S 


Laborer 


16 Dinsdale Square, New George Street. 


6*.. 


Female. 


4S 


Married 


I Green's Place, Vincent Street. 


6t.. 


Male... 


4Q 


Victualler,. . . 


Royal Oak Hotel, Spencer Street. 
5 Booth Street. 


13*.. 
i8».. 


Male... 


40 


Dustman.. .. 


Male. . . 


27 


Laborer 


21 Good's Avenue, Buckingham Street. 


18 . . . 


Male. . . 


6i 


Gardener 


10 Harcourt Terrace, Buckmgham Street. 


23*.. 


Male. . . 


64 


Fruiterer 


18 Naylor's Row. 


24».. 


Female. 


SS 


Married 


5 Ebenezer Place, Cumberland Street. 


26... 


Male... 


S3 


Contractor . . 


17s Walton Street. 



We have attached to our sanitary department a laboratory, in which orig- 
inal research can be carried out, and the committee recently appointed 

* Denotes deaths occurring in the hospital. 

t Denotes suspicious cases notified as Choleraic Diarrhoea, but in which the usual 
sanitary precautions were adopted immediately after death. 



32 NOTES ON CHOLERA, 

Dr. James B. Young, fresh from the University of Edinborough where he has 
been engaged for some months in carrying out bacteriological and micro- 
scopical researches. 

The precautions which are adopted in Hull, of what has been described 
as " the movement of a sanitary column," are as follows : 

Immediately upon the receipt of a notification of cholera (or of a sudden 
illness of a choleraic character), either by the medical practitioner in 
attendance, the sanitary inspector or the police, the medical officer of 
health is communicated with and immediately visits the case, or in his 
absence, his assistant. 

Should the case admit of removal, the horse ambulance, fully equipped, 
with trained men in attendance, is immediately requisitioned by telephone. 

The assistant inspector of nuisances for the district in which the case 
occurs, is forthwith acquainted, and makes his appearance with a column 
comprising flushers, lime-washers, and disinfecting staff. 

He superintends the removal of the inmates of the house to the hospit- 
al, for the purpose of bathing and disinfection of their clothing, the disin- 
fection of the house, together with all articles of bedding, clothing, etc., 
which has been exposed to infection, and the destruction of such articles 
as may be ordered by the medical officer of health or his assistant. 

The contents of the privy are removed to the destructor for cremation, 
and the interior cleansed, disinfected, and lime-washed. 

The subsidiary drains in the immediate contiguity of the house are thor- 
oughly flushed, and disinfectants are freely distributed in the neighborhood 
of the outbreak. 

DISPOSAL OF THE DEAD. 

The corporation of Hull have recognized cremation from a public health 
point of view, for the disposal of the dead, and have memorialized the local 
government board for power to use municipal funds for the erection of 
crematoria at our various cemeteries. 

I trust a bill will sooner or later be brought before the houses of parlia- 
ment, to apply the funds under municipal control so that the two systems 
of disposal of the dead may be tried side by side, and thus the public will 
have an opportunity of comparing the two systems. Those persons who 
have expressed a wish in favor of the disposal of their remains by burning, 
should have an opportunity of this being carried into effect, after the cause 
of death has been duly certified. This form of disposal of the dead com- 
mends itself; as often, from the over-crowding of our graveyards, they 
become a source of damage to the public health. 

In conclusion, our ports, while protecting themselves, are protecting the 
community at large ; and I believe that I am expressing the opinion en- 
tertained in England by port sanitary authorities generally, that the expen- 
ses incurred by these extra precautions, which are necessary for efficient 
port sanitary administration, should be contributed to in some measure by 
the imperial exchequer. 



IX. 

TROPICAL DIARRHCEA. 

By Surgeon-General Sir JOSEPH FAYRER, K. C. S. L, LL. D., M. D., F. R. S., 

Honorary Physician to the Queen, Honorary Vice-President of the Inter- 
national Congress of Public Health, Chicago, President of 
THE Medical Board at the India Office, London. 

London^ Eng, 

Tropical Diarrhcea — Synonyms — ^Where met with — Identity with white flux. 

Semiology — Character of dejecta — ^Tenderness of mouth and tongue — Diarrhoea 
not always a prominent symptom — Occasional evidences of malarial influence 
in outset and course of disease — Insidious progress — General degeneration 
rather than specific disease of any one organ. 

Morbid Anatomy — Intestines after death at an early stage contracted, and 
sometimes ulcerated — At later stage, attenuated, and the seat of fatty amy- 
loid degeneration — Most of the visceral organs shrunken, pale, and con- 
tracted — Wasting of tissues generally — Obliteration of villi in the tongue — 
Bacteriology. 

Treatment — Diet, milk, and milk alone, in small quantities and at regular 
intervals, for three weeks, a month, or six weeks — State of tongue chief indica- 
tion as to when this may be varied gradually and tentatively until normal diet is 
again reached — Warmth and absolute rest equally necessary — Drugs of but little 
avail — ^All these precautions to be carefully observed long after recovery is 
apparently complete — Removal from a tropical climate. 

tropical DIARRH(EA. 

Tropical diarrhoea, diarrhcea alba, white flux, sprue, psilosis (thin), etc., 
are S3monyins applied to a form of disease which occurs as the result of a 
residence in China, Cochin China, Batavia, Java, the Indian and Malayan 
peninsulas, Ceylon, and probably in other tropical and sub-tropical coun- 
tries, and occasionally in extra tropical regions. 

This is a form of disease which is generally, if not always, the result 
of tropical and climatic influences, and the debility and cachexia induced 
thereby. It is now not unfrequently observed in Europe, owing to the 
ever-increasing means of communication with foreign countries. It is 
apparently generally confined to adults ; is insidious in onset, slow in 
progress, and often, when not arrested sufficiently soon, fatal, owing to 
irreparable degenerative changes. 

It has been described by many observers, both English and foreign, in 
India, China, and Batavia ; most of the cases seen in this country come 
from China, India, or Ceylon. In India it is met with frequently, where 



34 TROPICAL DIARRHCEA. 

a form of it is known as hill diarrhoea, from its proneness to affect 
dwellers in hill stations, especially those who have previously lived in the 
plains ; atmospheric Changes, vicissitudes of temperature, greater altitude, 
rarified atmosphere, and possibly water being concerned in its causation. 
Some authorities consider it a distinct disease from the white flux, which 
may be seen in any part of the country, but they are so much alike as to 
justify the belief in their identity, at all events for practical purposes. 
Occasionally there is a resemblance to certain forms of chronic dysentery ; 
the two conditions may be associated, or one may merge into the other. 

Tropical diarrhoea occasionally makes its appearance years after the 
subject of it has returned from the tropics. It not unfrequently begins 
without any previous apparent derangement of health (though it is some- 
times preceded by dysentery, diarrhoea, some indication of malarial infec- 
tion, or functional derangement of the liver or other abdominal viscera), 
and is not noticed until excessive soreness of the tongue, loss of strength, 
and wasting reveal the gravity of the condition. 

People in this country suffering from malarial cachexia are apt to be 
troubled with diarrhoea of an irregular character, which may, if not 
promptly dealt with, be the precursor of the chronic form, and is often 
obstinate enough, especially if there be hepatic or splenic complications, 
or any vestige of previous dysentery, but it is not so grave in character as 
the white diarrhoea. This latter, however, in all its forms, is compara- 
tively amenable to control, if carefully and promptly treated at the 
outset, and unattended by structural changes in the viscera. 

SEMIOLOGY. 

This form of diarrhoea, as before said, may begin with simple loose- 
ness of the bowels, or may supervene on ordinary diarrhoea or chronic 
dysentery. The action produces a sense of relief. The dejecta at first 
may be natural and vilious, but gradually become light-colored, frothy, 
pultaceous and copious. As the disease advances, they are occasionally 
tinged with blood, and the sufferer becomes more attenuated, exhausted, 
and incapable of any prolonged exertion. The appetite may be good, but 
rawness and tenderness of the mouth and tongue, frequently accompanied 
by aphthous spots and ulceration, interfere with its gratification. Defi- 
ciency of bile is suggested by the appearance of the dejecta, whilst the 
microscope detects vegetable and fibrous tissue, or other portions of the in- 
gesta passing unaltered, as well as certain forms of micro-organisms. 
This light color, which is irrespective of the nature of the diet, is not due 
to any specific disease of the liver, which only shares with other organs 
the shrinking due to general wasting. 

Diarrhoea is not always a prominent symptom of this disease, and cases 
occur, — more frequently, according to the author's experience, in patients 
from Ceylon, — where general wasting and soreness of the tojigue are the 
chief characteristics, though, at the same time, the excreta are not normal. 



TROPICAL DIARRHCEA, 35 

The subjects of tropical diarrhcea are pale and emaciated, with skin 
dry, flaccid, sallow, and sometimes pigmented in patches. The abdomen 
is soft and flaccid ; the eyes become pearly and sunken, the gums pale 
and shrunken, the lips and conjunctivae blanched and anaemic. The 
tongue, at first pale and flabby, becomes shrunken, red, and glazed, the 
papillae are obliterated, it is raw, smooth, and tender, often affected, as 
is the buccal mucous membrane, by aphthous ulceration, and in some 
cases covered with a thick coating of white epithelial scales. The 
state of the tongue is generally significant of the stage of the 
disease, return to the normal condition being a hopeful sign, whilst 
increased smoothness and tenderness, with aphthae, are of evil augury. 

Evidences of malarial influences are shown in the outset, and some- 
times in the course of the disease, by recurrences of fever, by vague 
conditions of malaria, or myalgic or neuralgic disorder. 

The symptoms described may be mitigated by treatment, but the im- 
provement is often more apparent than real. The disease slowly and 
surely progresses, until the patient is compelled to seek change of climate. 
Should this be of no avail, the symptoms increase in gravity, the breath- 
ing becomes feeble and accelerated, temperature sub-normal, extremities 
cedematous, anaemia is profound, and the urine often albuminous ; cat- 
amenia are suspended or diminished. If this evil condition be not 
arrested, and it seldom is when it has gone so far, fatal exhaustion, or 
pulmonary embolism, or thrombosis soon closes the scene. 

This condition appears to be the consequence of general degeneration, 
rather than specific disease of any one organ, though the intestinal tract 
seems to be the seat of the most marked change. 

MORBID ANATOMY. 

Where death has occiured at an early period, the intestines have been 
found .contracted, with the mucous lining thickened, congested, and 
even ulcerated ; but when at a later period, the coats of the bowel are 
found to be attenuated, diaphanous, and the seat of fatty and lardaceous 
degeneration, with occasional ulceration in the ileum or colon. The 
intestinal and mesenteric glands are atrophied and degenerated, the 
latter sometimes enlarged. The mesentery itself is wasted, the liver 
shrunken, pale, and contracted, so as in life to have given rise to the 
belief that it was specially atrophied ; the spleen, pancreas, and kid- 
neys are in a similar condition ; occasionally, though not in ordinary cases, 
there may be chronic enlargement of liver or spleen, or of both. There 
is not so much surface change, as thinning of all the coats of the small 
intestines, so that they become translucent ; when dysenteric symptoms 
have appeared, ulceration of portions of the colon has been found. 

According to the experience of Dr. McConnell, professor of pathology 
in Calcutta, amyloid degeneration of the bowel is rare among natives of 
India, but he confirms the accuracy of the account given by Dr. D. D. 



36 TROPICAL DIARRHCEA. 

Cunningham, of the morbid anatomy of the intestines of the sufferer 
from chronic diarrhoea and dysentery in famine seasons. The valuable 
report of the latter on the famine diarrhoea, — of which the condition is 
probably analogous to that now under consideration, — shows how the 
degenerative changes involve the intestines as well as the other viscera, 
and the general result of the entire series of observations on the morbid 
anatomy is to show that the diseased conditions were specially character- 
ized by extreme general anaemia, and destructive processes affecting the 
mucous membrane of the intestinal canal. This latter characteristic is 
also pointed out by Aitken and Virchow. The absence of epithelium and 
obliteration of villi are very remarkable in the tongue, and besides these 
characteristics, an absence of fat and a wasting of the tissues generally 
are conspicuous. 

With regard to the bacteriology of the diseased conditions due to 
tropical diarrhoea. Professor Macfadyen points out, that in the normal 
bacteriology of the digestive tract there are a large number of bacterial 
species, and that this is the case also in the normal small intestine, no 
one kind predominating. Its contents had a faintly acid reaction, which 
had inimical effects on the growth of organisms. The bacteria normally 
present in the small intestine ferment carbohydrates, but do not decom- 
pose albumens. 

Dr. Macfadyen found stools from a case of tropical diarrhoea to be 
crowded with micro-organisms, of which one kind, a bacillus, predomi- 
nated ; it was like the anthrax bacillus, somewhat thickened, with flat- 
tened ends, and motile. He found no amoeboid organisms, but, — as he 
remarks — that does not prove that they were not there. It has, he main- 
tains, undoubtedly been proved that in some diseases of the digestive 
tract, occurring in hot climates, large numbers of amoeboid organisms are 
to be found in the large intestine. Many interesting investigations into 
this subject have been made by Kartulis, Osier of Baltimore, Council- 
man and Lafleur, and others, but we are not yet in a position to assign 
them a definite role in the causation of intestinal disease. 

Dr. Thiu describes the cultivation of thirteen distinct forms of organ- 
isms that he obtained from a case of this kind, and their different effects 
on the gelatine. In a more recent communication (April, 1892,) he 
brings forward reasons to show that in the so called sprue the reactions 
of the intestine are abnormal, and argues that this must produce ab- 
normalities in the development of the bacteria normally present in the 
bowel, which in its turn might account for the abnormal coloring of the 
stools. 

TREATMENT. 

From the insidious character of the disease, tropical diarrhoea not 
unfrequently gains ground before radical measures for its relief are 
resorted to. Successful issue depends much on the patient's resolution 
and perseverance in carrying out instructions. Alternations of tempera- 



TROPICAL DIARRHCEA, 37 

ture, errors of diet, fatigue or excitement, exertion, mental or physical, 
should be avoided ; physiological rest should be insisted on. 

There is a tendency in the earlier stages to get well. The object is to 
favor this tendency, and not to thwart it by neglect of precautions. Diet 
is the most important consideration, and must be strictly regulated and 
adhered to; and scarcely less important is the question of clothing, 
habits, and mode of life. 

Milk alone should be the only diet, and it must be given in small 
quantities, often repeated, say from four to six ounces every hour, day 
and night. Larger quantities at longer intervals will not do. When in 
the twenty-four hours, an adult is able to take three to four quarts of 
cows' milk in this way, ample nourishment is afforded to support his 
strength and to enable him to recover. 

This method of treatment was begun by the author of this paper 
before leaving India in 1872 ; after prolonged experience and trial of all 
other forms of remedies, he has found it more effective than anything. 
It seldom fails, except in the very advanced and chronic cases, or in very 
aged persons. 

In ordinary cases it must be adhered to for three weeks, a month, or 
six weeks, when changes or additions may be tentatively and gradually 
made. Occasionally it may be expedient to add a little water, lime or 
soda water, but it is seldom necessary to dilute the milk. Tea, coffee, 
or cocoa as a general rule disagree. Alcoholic stimulants for those who 
have long been accustomed to them may be necessary, but should be 
cautiously administered in limited quantities (from two to six ounces a 
day). The best are old brandy or whiskey, given with the milk or some 
alkaline water. As a rule, all wines are unsuitable. 

Regularity in times of administration, and the quantity of milk given is 
most essential. It is generally well to begin with two or three ounces per 
hour, increasing to six ; in very aggravated cases it may be expedient to 
give an ounce to two ounces every half hour. If, after three weeks or 
a month, the diarrhoea has entirely ceased, and for some time, if the 
tongue be less red and sensitive, and if the papillae have reappeared, a 
slight addition may be made, but not unless this is the case. After taking 
the milk for some days, the tongue becomes coated with white fur, but is 
less red at the tip and edges ; the aphthae, often present, disappear, as 
well as the abnormal sensitiveness. The diarrhoea gives place probably 
to constipation, the patient feels in all respects better. When this con- 
dition has been attained, a change in diet may begin. 

At first, bread, not recently baked, may be added* in small quantities, 
gradually increasing, thoroughly incorporated as crumbs in the milk. 
After a week or so, a little finely minced mutton or chicken, not pre- 
viously cooked, may be given, and if the improved condition continues, a 
little light pudding or other farinaceous food should be given, followed 
by a very tentative and gradual return to meat and vegetables, and other 
light food, but if any sign of irritation recur, milk diet should be at once 



38 TROPICAL DIARRHCEA. 

resumed, and continued till all disturbances have ceased. It is very 
difficult for the patient to realize the danger of indiscretion and the need 
for care and caution, but these difficulties are often surmounted, and com- 
plete recovery takes place. 

In addition to these precautions in diet, others must be observed. 
These are warmth, complete rest, and, if possible, residence in some mild 
and sheltered locality. The latter, however, is not to be insisted on if it 
involves the loss of care, comfort, and attention of home nursing any- 
where. The greater part of the twenty-four hours should be spent in a 
recumbent position, at any rate in the earlier stages. As the condition 
improves, — of which the state of the tongue, as well as diminution of 
diarrhoea, is the best indication, — the patient may take moderate exer- 
cise, but all fatigue should be avoided. 

For long after recovery is apparently complete, vicissitudes of tempera- 
ture, over-fatigue, and errors in diet must be carefully avoided. It may be 
necessary to delay return to a tropical climate for a year, if not in- 
definitely. 

The careful use of saline laxatives, combined with some bitter in- 
fusion, in the early morning may be beneficial to relieve abdominal 
plethora and portal congestion, but care must be taken not to produce 
over-action. To allay irritability and to give tone, small doses, — three 
to five drops, — of liquor arsenicalis twice a day, continued over a period 
of weeks, with occasional breaks of three or four days, may be beneficial. 
When the bowel is very irritable, with pain and a tendency to watery dis- 
charges, doses of five to ten minims of Tr. opii, or a few grains of 
Dover's powder, may be useful. Later on, as recovery progresses, mild 
preparations of iron, expressly the Potas. Tart., may be beneficial. 
Experience, however, has shown that with the exceptions already alluded 
to, drugs are of little use. 

The hygienic and dietetic precautions alluded to are generally success- 
ful, unless visceral complications of a structural nature have occurred, or 
the patient be exhausted by age or debility, or the disease be in a very 
advanced stage. Unhappily, many who fall in the latter category suc- 
cumb, whilst some suffer frequent relapses from neglect of rules laid 
down, and die from inanition and exhaustion. Hence the necessity for 
early treatment and rigid adherence to the simple, though irksome, regi- 
men, which experience has shown to be the best. When the milk has 
failed, it has frequently been because it had been mixed with other food, 
or taken in irregular intervals and in large quantities at a time. 

The conclusion arrived at is, that though drugs are generally of little 
avail, if milk, taken as prescribed, does not succeed, there is but small 
chance that any other form of treatment will do so. 



CHOLERA INFANTUM: ITS TREATMENT. 

By MANUEL SEPTlfiN, President of the Board of Health, 
Queritaro, Mex, 

There is scarcely any disease that causes a greater amount of mor- 
tality in childhood than that known by the name of estival diarrhoea, or 
infantile cholera. In one single week, the last one of July of the present 
year, 1,126 deaths occurred in thirty-three of the largest cities of England, 
caused by this disease alone. Statistics show everjrwhere a notable in- 
crease in the number of deaths during the months of June, July, and 
August, that is to say, during the warmest season of the year. The 
malady is not limited to children only, but attacks also a great number of 
adults and old people (cholera nostras), being less mortiferous in the lat- 
ter than in the former, in whom it causes a mortality of 50, 60 and even 
80 per cent. Only Asiatic cholera, to which it has the greatest similarity, 
can be compared to it for its ravages. 

It is undoubtedly of microbic origin, as recent investigations have 
proved. It is not determined by substances of difficult digestion in the 
digestive tract, for it presents itself with the greatest frequency in chil- 
dren who take no more food than the maternal milk. Micrographic 
studies have revealed the presence of a special bacillus of very small 
dimensions, having a rounded form, and which abounds extraordinarily in 
the excretions to such a degree that in grave cases they are formed almost 
entirely of the organism in question, mixed with a little mucus and bac- 
teria of putrefaction and of amaeloid bodies similar to those found in 
dysentery, which are probably white corpuscles altered. The bacillus 
is not found in the blood, nor in the organic tissues, the epithelium of the 
kidneys is inflated and degenerated, the nutrition of the lungs suffers, 
and that explains the broncho-pneumonia that is so frequently found in 
the autopsies. These anatomical alterations are probably the result of 
the accumulation of ptomaines in the blood and the rapid abstraction of 
water from the tissues that are revealed by the abundant vomits and 
evacuations that characterize this disease. The expoliation that the 
organism suffers is such that in a few hours the most robust children,* in 
the most severe cases, are turned to mere mummies. 

But this energetic drainage is only the supreme effort which nature 
executes to rid the organism of the deleterious elements that poison it. 
To try to suppress it by therapeutical means is not an easy or a rational 



40 CHOLERA INFANTUM: ITS TREATMENT 

thing to do ; it would only hinder the natural curative process. The only- 
thing that can be done is to oppose the extreme aqueous depletion of the 
tissues by restoring to them without delay at least a part of the water 
lost. This is the supreme therapeutical indication, and no drug can take 
its place, nothing but pure cold water. 

All the curative methods tried leave much to be desired ; their results 
are very precarious ; all consist in the administration of various medi- 
cinal substances, now astringents, now absorbents, antiseptics or anti- 
peristaltics, and in the prescription of some alimental regimen. Such 
treatments are not in conformity with the great principle that governs 
therapeutics : viz., The rest of the organ that suffers. 

In the disease of which we are treating it is very easy to act up to this 
great principle, seeing that the disease is of very short duration ; one or 
two days being the length of time that the gravity lasts. It is perfectly 
compatible with the life of an individual to suppress all food for 24 or 4S 
hours. Besides, the condition of the mucus of the digestive tube will 
not permit the absorption of any medicinal or alimental substance. The 
enormous exhalation that is verified in it prevents all digestive and 
assimilative work, as the exosmotic current has drawn off all the liquids 
that contribute to digestion. Only the water administered to the patient 
in great abundance, on occupying the stomach and intestines will be able 
to oppose a mechanical obstacle to the pathological exudation, in tiun to 
be absorbed, since it requires no digestive work, but penetrates to the cir- 
culatory current by the simple act of imbibition, going to restore to the 
blood the water lost and helping the skin and kidneys to eliminate the 
poison that circulates through the whole body. In this physiologic-path- 
ological condition is founded the most efficacious curative method for 
infantile cholera, proposed by Luton of Reims. 

All of us physicians who practice in the city of Quer^taro, Mexico, 
have employed it for several years, and we are witnesses of its marvellous 
results. We have the conviction of having saved by it innumerable lives, 
producing veritable resurrections; even we are amazed when we find 
them sunk in a state of collapse, wasted, cold, pulseless, breathless and 
without strength even to cry, with the mouth dry like parchment, to see 
them return to life again with a simple glass of cold water; it causes 
amazement to see them, from the moment they hear the precious liquid 
being poured in the glass, open their almost closed eyes, and direct their 
little hands towards it, as though they would like to snatch it from us. 
Then, they drink away without satisfying themselves, stopping only to 
take breath, and so on, until they drain the last drop from the glass ; after 
a few minutes they generally vomit all the liquor they have drunk. If 
water is again offered to them, they turn to drink it with the same eager- 
ness, falling directly in a tranquil and refreshing sleep. Generally they 
do not vomit again, and from that moment you can consider success 
assured. 

On awakening, it is noticed that the aspect of the little patient has 



CHOLERA INFANTUM'. ITS TREATMENT 4I 

changed completely, the features are already animated, the heat of the 
body begins to reappear and the pulse begins to make itself perceptible. 

This most simple of treatments once undertaken ought not to be aban- 
doned, which consists in the absolute suppression of all food and medi- 
cine for 24 hours, or, at the most, 48 hours, and administering pure cold 
water in abundance. 

Afterwards, the only thing that remains to do is to restore slowly and 
gradually to a convenient alimental regimen. A small quantity of milk is 
added to the water, increasing it little by little, until by the end of three 
or four days nothing but pure milk is given. If the complete cure is not 
made in this short space of time, it is a sign that the milk is doing harm, 
and ought to be suppressed completely, substituting instead rice gruel, a 
food at the same time nutritive and constipating. 

Let me strongly call the attention of this assembly on this point : 
The suppression of milk in cases of diarrhoea. 

Although the milk regimen is advised by the greatest practitioners as 
the most adequate in gastro-intestinal diseases, at times it is not tolerated, 
and the evil continues, in spite of the best of treatments, until the milk 
is abandoned, replacing it by various gruels, principally of rice. This 
assertion is based on my already large practice, both as much in my own 
numerous family of ten children as in that of my clientship of 25 years. 

Even the milk, rendered sterile by repeated boilings, gives equally un- 
favorable results, perhaps for the great tendency that it has, like all 
organic substances, to decompose, especially in hot weather. 

When once the acute period of the disease has passed, nitrate of 
silver in solution (5 centigrams to 50 grams of distilled water) may be 
prescribed ; calomel in very small and repeated doses, or the most power- 
ful antiseptic that we know, bi-chloride of mercury in the form of Van 
Swieten's liquor, six drops every four or six hours, in a mixture of equal 
parts of water and mucilage. 

Opium, bismuth, and especially salol, which gives most brilliant results, 
will complete the treatment. 

A very important recommendation during the critical period is to ad- 
vise the keeping of the child in the most complete quietness ; not per- 
mitting him to sit up, even to vomit, giving him water in a very clean 
sucking-bottle, covering the body with blankets and placing bottles of 
hot water around the patient to give him heat. 

If any indication should present itself, where it would be necessary to 
• stimulate the hearths action, various hypodermic injections may be applied. 

If the inclination to vomit persists in impeding the administration of 
water to the stomach, salt water injections may be given in the proportion 
of 6 per 1,000, in the sub-cutaneous cellular tissues, by means of a small 
exploring syringe. 

A very important point, and one that should never be forgotten, is that 
the disease is very infectious, and for that reason every precaution ought 
to be taken to avoid its transmission to other children, and even to adults. 



42 CHOLERA INFANTUM: ITS TREATMENT 

Contagion will probably take place by the dissemination in the air of 
the drying vomits and evacuations on the clothes, and by these means 
contaminating the foods and drinks. 

In the Mexican Medical Congress, that took place last year in the 
capital of the Republic, I presented a paper on the treatment of Asiatic 
cholera, based on the same principles as those which I have expounded 
to combat infantile cholera. 

Happily, we have not had an opportunity of trying it, but I think that 
if it should make an appearance, a trial of it ought to be made ; more so, 
seeing that there does not exist any proper treatment against a disease so 
terrible. 

One half of those attacked (more or less) terminate fatally, whatever 
may have been the curative method employed. 

Until now only the energetic preventive measures employed in the 
United States and Great Britain have given the most satisfactory results. 

Therapeutics are impotent, once the disease has declared itself. The 
reasoning that I expounded in that medical reunion was the following : 
Asiatic cholera is a disease analogous to summer cholera to such a degree 
that they are often confounded ; both are of microbic origin ; they breed 
in the same season of the year, and never, or very seldom, in winter ; 
the clinical features are identical in the two cases, and the death-rate is 
almost equal in both. If we, then, cure infantile cholera so efficaciously 
with the method that I have described, it is possible, and I believe I can 
say it is probable, that it may be applied to the other with equal or like 
success. 

Although they may be two distinct morbid entities, that should be no 
reason why it would be absurd to apply the same treatment when they 
have between them such a common affinity. 

Typhus exanthematicus and typhoid fever, two diseases, although dis- 
tinct, have great analogies, and are susceptible to the same treatment, and 
so, like this, other examples can be found. 

It appears to me very opportune to choose this subject and present 
it before the American Public Health Association, who have appointed 
Wednesday's session to treat precisely on the diseases that affect the 
alimental canal. 

The recent summer epidemic, which in some parts has been so very 
severe, has served to confirm the existence of the microbe that originated 
it, and the pathological alterations of which I spoke at the beginning, 
according to the last numbers of the London Lancet 

I have the firm conviction that the American Public Health Associa- 
tion would do a true service to mankind if they would deign to give their 
high approbation to the simple method of which I have spoken, which 
can be reduced to the three following precepts : Firstly, to suppress all 
nourishment and medicine for one or two days ; secondly, to give at dis- 
cretion pure cold water; thirdly, to return by degrees to a rational 
regimen. 



CHOLERA INFANTUM: ITS TREATMENT, 43 

These precepts could be recommended to the infants' protective 
societies, nursing institutions, lying-in hospitals, etc., and, in a word, 
it could be made known everywhere by every possible means. 

This Association would only have to say the word and it would very 
soon be adopted in the three great countries which it represents. 



XL 

THE SEWAGE DISPOSAL PROBLEM IN AMERICAN CITIES. 

By ALLEN HAZEN, 

Chemist in Chargr Lawrence Experiment Station, Massachusetts 
State Board of Health, 

Lawrence^ Mass. 

One of the striking features of the sanitary development of American 
cities is the very rapidly increasing number of places which, for one 
reason or another, are treating in some way their sewage. It is not so 
very many years since there was hardly a sewage purification plant in the 
United States, while at the present time there are some thirty municipal- 
ities in a dozen different states which give their sewage a more or less 
thorough treatment. Of these a number are in the far West, where the 
sewage has a commercial value for irrigation, which has probably been 
considered quite as important as the sanitary advantages secured by the 
treatment, but the greater number are in the East, where a dense popu- 
lation and increasing desire for cleanliness in the waters of streams and 
lakes, and particularly in water supplies, has brought to an issue problems 
which as yet have scarcely received the attention of the inhabitants of 
the less thickly settled states. 

Strictly speaking, there are two sewage problems, which are entirely 
different in their natures, although the same remedies may often be 
applied to both. There is, first, the pollution of rivers and lakes to such 
an extent that they produce a nuisance to the people who live upon their 
banks, and second, the pollution of water supplies by sewage. These 
problems are entirely distinct, and failure to sharply discriminate between 
them has been responsible for not a little misunderstanding in regard to 
methods of sewage disposal. 

The first case is often that of a city upon the banks of a small river, 
which becomes so reduced in volume in dry weather that the sewage may 
fairly be said to be the predominating element in its composition. Up to 
a certain point, rivers are capable of taking sewage without causing a 
serious nuisance to the people who live upon their banks, so long as they 
do not drink from them, but when this quantity is passed, deposits are 
formed, decomposition sets in, and the stream is rendered foul in appear- 
ance and objectionable in its odor. The exact quantity of sewage which 
can be mixed with water without causing a nuisance varies with local 
conditions, and can only be approximately estimated, but so long as the 



THE SEWAGE DISPOSAL PROBLEM, 45 

limit is not passed, and with bodies of water not used for drinking, the 
disposal of sewage by turning it into such water is entirely unobjection- 
able, and by far the most satisfactory method possible. Thus the con- 
struction of purification works for the sewage of the cities on the lower 
Merrimack, below the points where it is used for public water supplies, 
would be sheer waste of money much needed for other public improvements. 
When, however, the limit is passed, and the sewage becomes so large 
a proportion of the volume of the water with which it mixes that an 
actual nuisance is produced, then a remedy is demanded. The necessary 
purification of the sewage consists in this case in the removal of the 
organic matters of the sewage, which are the sole cause of the decompo- 
sitions and the offensive appearances and odors which accompany them. 
So long as the sewage does not find its way into drinking water, the 
removal of the bacteria from the sewage is a matter of no consequence 
whatever. If the germs of disease in a river were capable of affecting 
those who only live near it, it is not hard to think of parts, at least, of 
cities which would have been entirely depopulated long ago. 

But in the second case, where the sewage of a town is entering the 
public water supply of a neighboring town, or, worse yet, its own supply, 
the problem is entirely different. The removal of the organic matters of 
the sewage becomes a secondary, although still an important matter, 
while the removal of those germs of disease, which would otherwise work 
such mischief among the consumers of the water, becomes the one all 
important point. 

The problems of the first class have, perhaps, received more attention 
than those of the second, because a black, dirty stream, giving off sul- 
phuretted hydrogen, is more obviously a nuisance than is a polluted water 
supply, the relation of which to the health of the community is too often 
but imperfectly realized, even by those having such matters in direct 
charge, and much less by the mass of voters and taxpayers, whose sup- 
port must be obtained before any expensive improvements are possible. 

When, however, we think of the compactness with which great sections 
of country in the neighborhood of large cities are being settled, and the 
growing difficulty in such cases of securing a water supply, even approx- 
imately free from sewage contamination, it becomes apparent that the 
protection of our water supplies will require the construction of increas- 
ing numbers of sewage purification plants, in which nothing short of the 
complete removal of the bacteria of the sewage will be accepted as 
satisfactory. 

Turning now to the methods of sewage treatment, we may divide them 
broadly into two classes, the first of which by mechanical means, usually 
with the aid of chemicals, seeks to remove the grosser impurities from the 
sewage, while the second, by applpng the sewage to land, at once dis- 
poses of it, and at the same time often allows a partial utilization of its 
fertilizing value by the crops which may be grown upon the land. 

Of the first class of processes, only those treatments commonly 



46 THE SEWAGE DISPOSAL PROBLEM, 

designated as chemical precipitation have shown themselves capable 
of advantageous application. Chemical precipitation consists briefly in 
adding chemicals to the sewage which form in it a precipitate which 
coagulates, and weights the organic matters, which are then allowed to 
settle out in properly constructed tanks, while the rest of the sewage 
flows away in a more or less clarified condition. These processes have 
been extensively used in England and also in Germany and at several 
places in America. The chemicals employed are varied in different 
places, but the underlying principle is always the same. The tanks in 
which sedimentation is obtained are of varied shapes, large, shallow tanks 
being employed at Worcester, Mass., White Plains, N. Y., East Orange, 
N. J., and at Canton, Ohio, while the plant which treats the sewage from 
the World's Fair grounds, and is itself an exhibit, is provided with high 
cylinders, through which the sewage slowly rises, leaving the precipitate 
upon their specially prepared bottoms. 

Chemical precipitation at best is only able to remove the bulk of the 
suspended matters of the sewage, with a small part of the soluble mat- 
ters and a certain proportion of the bacteria. The effluents obtained are 
much less likely to produce a nuisance in streams than is raw sewage, 
and in those cases where the purity of a drinking water is not involved 
the result may be quite satisfactory. 

The possibilities of sewage treatment by chemical precipitation are 
substantially the same the world over; local conditions are only of 
secondary importance. It is otherwise with the land treatments. With 
them the local conditions are of contioUing importance, and make the 
general problem far more complex than would otherwise be the case. 
Land treatments have been long and extensively used in Europe, and 
some general conclusions have been deduced from the results there 
obtained, which are useful for corresponding conditions in this country. 
The experiments undertaken by the Massachusetts State Board of Health 
at the Lawrence Experiment Station some six years ago indicated that 
the local conditions in Massachusetts would allow the treatment of 
sewage upon land often with more favorable results, both as to quantity 
of sewage treated and quality of effluent obtained, than had been sup- 
posed to be the case from a study of European practice. 

The results of those experiments have not only shown the superior 
natural advantages for sewage purification existing in Massachusetts, 
but they have indicated arrangements of materials and methods of prep- 
aration of the surface of land, which allow even better work than would 
otherwise be possible. They have also led to a better understanding of 
the underlying principles which enable us to make calculations in regard 
to the capacity of and results to be obtained from the various materials 
and combination of materials available at different points, and in this 
way avoid the useless expenditure of money and the disappointing results 
almost sure to follow the construction of badly arranged works or the use 
of unsuitable materials. 



THE SEWAGE DISPOSAL PROBLEM, 47 

The practical value of the experimental results obtained at Lawrence 
has been amply demonstrated by the application of the methods found 
most useful to the arrangement of sewage fields for the purification of the 
sewage of several towns of considerable size. Among these the South 
Framingham filter beds were the first to be put in operation some four 
years ago. The sewage is pumped on to a field of coarse porous sand, suit- 
ably arranged to receive it, and rapidly filters away and becomes purified 
to such an extent that the undiluted effiuent from the underdrains is prefer- 
able as a beverage to some public water supplies now in use. The costs, 
both of construction and operation of this plant, have been very mod- 
erate, and are not to be compared for an instant with the advantages of 
diverting the sewage of ten thousand people from Boston's water supply. 
Works more or less like those at South Framingham are also in use at 
Marlborough, Gardner, and other smaller places in Massachusetts, while 
Brockton has just completed a larger plant, built upon the same general 
plan. 

If the kinds of soil which have proved themselves so useful in Massa- 
chusetts were ever3rwhere available, we might well congratulate ourselves 
that the sewage problem had at last been solved, and we should then 
waste no time upon more costly and less complete methods of purifica- 
tion. But unfortunately the open, sharp-grained sand of New England is 
a rare article in large sections of our country, and for those places where 
it is lacking the experiments of the Lawrence Experiment Station have 
only a suggestive value. They may indicate in some measure the 
methods likely to 3deld the best results, but they do not give any accurate 
idea of the results which can be obtained with an entirely different class 
of materials from those with which the experiments have been made. 

We can infer from European experience that many, perhaps most of 
these inferior materials are capable of purifying sewage at rates much 
lower than those followed in Massachusetts ; but how much lower until 
additional data are secured, it must be more a matter of guess-work than 
of conservative calculation. It has been our experience that the terms 
used to designate different classes of materials have such decided local 
variations in their significance that it is not safe to depend upon verbal 
description in estimating the values of materials, and it has been an 
important part of the work at the Lawrence Experiment Station to develop 
methods of examination of materials, by means of which their physical 
properties can be determined with some measure of accuracy. In this 
way we have been enabled to classify materials, and within the limits 
covered by the experiments to make reliable estimates of their power of 
sewage purification. 

In those places where the open sands for intermittent filtration, as 
practised in Massachusetts, are not available, and for one reason or 
another the land treatment at lower rates, so commonly used in Europe, 
cannot be applied, we can still use chemical precipitation. This was the 
condition of affairs on the World's Fair grounds, where the small area of 



48 THE SEWAGE DISPOSAL PROBLEM. 

extremely valuable land available for the sewage works was totally unfit 
to receive the quantity of sewage which it was desired to purify before 
turning it into Lake Michigan. The chemical precipitation plant, which 
is now doing the work, perhaps purifies more sewage, in proportion to the 
space it occupies, than any other plant in existence doing corresponding 
work. The entire area covered is hardly more than a quarter of an acre, 
and the sewage treated, sometimes exceeding three million gallons daily, 
would be sufficient to fiood the entire area over thirty-five feet deep in a 
single day. 

It is impossible by any combination of chemicals to secure a purifica- 
tion which approaches, even remotely, the result obtained by land treat- 
ment, but when the problem is simply to keep the water into which the 
sewage flows reasonably clean, the result, with careful manipulation, is 
quite satisfactory. When, however, the treated sewage finds its way into 
the sources of a public water supply, the effluent produced by even the 
most complete chemical precipitation cannot be regarded as an entirely 
unobjectionable addition, and such water should be farther treated by 
filtration before use. Still, even in this case, the treated sewage is much less 
objectionable than raw sewage, and the removal of over a thousand tons 
of solid filth from the World's Fair sewage during the past month, while 
it has not protected the water cribs from the vastly larger volume of 
untreated sewage from the city, has at least materially reduced the con- 
tribution from the park. 



XII. 

THE COLLECTION AND DISPOSITION OF ANIMAL AND 
VEGETABLE WASTE IN THE CITY OF MILWAUKEE. 

By U. O. B. WINGATE, M. D., Commissioner of Health, 
Milwaukee, Wie. 

The city of Milwaukee is located eighty-five miles north of Chicago. 
It has a population |of about 260,000, and has for several years, and is 
now growing at the rate of about 1,000 a month. 

As early as 1879, the city began to grapple with the garbage problem, 
and it has been a long and serious struggle until a recent date. 

One of the first problems that was very satisfactorily settled at an 
early date was the enforcement of an ordinance requiring citizens to 
keep garbage and offal from being mixed with ashes and other rubbish. 
This was accomplished by having circulars struck off, and thoroughly and 
often circulated through the city by officers of the health department and 
those engaged in the coUection of garbage. 

Almost every known method has been tried by the city for the dis- 
position of this material. It has been fed to swine ; it has been ploughed 
under the ground by fanners; it has been buried; it has been pitted; 
attempts have been made to bum it in everything, from a cook-stove to 
the most elaborately constructed crematory, but there did not seem to be 
any satisfactory solution of the problem. 

The health department in times past has been literally flooded with 
all kinds of schemes for the disposition of this material Everyone who 
had a scheme was sure that his was the proper one to adopt, llie health 
officer was placed continually between two fires, the public on the one 
side demanding the removal and destruction of their garbage, on the 
other hand a string of schemers pouring in their plans to settle the 
problem. Why the health officer was not driven to an insane asylum 
must remain a mystery. 

In 1888, after a struggle with several systems of cremation, the city 
entered into a contract with a company for a term of three years for the 
disposition of garbage and small dead animals by a system which utilized 
this material, but did not destroy it ; but the plant in which this system 
was to be used was built in a very unfortunate location inside the city 
limits, being situated in close proximity to several slaughtering establish- 
ments, and near an open marsh, which had been used for several years as 
a dumping ground, and which in hot weather emitted all kinds df odors. 



50 DISPOSITION OF GARBAGE IN MILWAUKEE. 

No complaints were made a^nst this plant, except during the summer 
months ; and every odor that emanated from this locality was laid at the 
door of the garbage plant. Careful investigations were made both by 
the health department and by citizens, and there were about as many 
ideas expressed concerning the source of the nuisance as there were 
complainants against the same, but there was a very strong opposition to 
having the plant located in that locality, and appeals came in often to 
have it closed. As the cool weather came on, and during the winter 
months, complaints ceased. 

The collection of this material was made by the city, under the super- 
vision of the health department, and was very satisfactory. At that 
time about thirty tons of animal and vegetable refuse from the table and 
kitchen, including small dead animals, such as dogs, cats, and rats, etc., 
and the confiscated meat and vegetables condemned by the health de- 
partment were disposed of in this plant daily. 

In the summer of 1891 it became evident to the health department 
that the plant was being overworked, the water supply was not sufficient 
for the purpose of condensing gases properly, the building had become 
shaky, and the machinery was not working properly; offensive gases were 
escaping and creating a nuisance, and not from the fault of the process, 
but from the location, construction, and management of the plant, it was 
deemed advisable to close the plant a few months before the expiration 
of the contract. 

There was a great deal of trouble just before the plant was closed, 
caused by complaining citizens, who claimed that the " Garbage Factory " 
was a great nuisance, but more trouble was in store as soon as the plant 
was closed. An attempt was made to dispose of the garbage for a while 
on farms outside of the limits of the city, but the towns promptly put an 
injunction on such business. The only relief for the city then was to 
dump the garbage into the lake. The custom had been established of 
collecting the garbage in the city, and the people demanded the garbage 
collected by the city, and the health department must dispose of it in 
some way. The city attorney decided about this time that there were no 
provisions authorizing any city official to make a contract with any com- 
pany or person for the disposition of this material, but there was power 
given to the commissioner of health to employ as many teams as was 
necessary for the collection of this material and to remove the same to 
such place or places as the commissioner of health might direct 

There was no plant in which it could be consumed or treated, and the 
adjoining towns prohibited its being taken within their limits. There 
was but one course to pursue, and that was to dump it into the lake. 
Here the fishermen objected, and instituted injunction proceedings, but 
were beaten in the courts, and the injunction dissolved. 

In the winter following, i89i-'92, the state legislature passed an act 
authorizing the common council of the city to enter into a contract for 
the disposition of this material, with the advice of the mayor and the 



DISPOSITION OF GARBAGE IN MILWAUKEE, 5 1 

commissioner of health. Then began a siege with the schemers again ; 
all kinds of plans were suggested, and every one who suggested a plan 
was sure that his plan was the best. Much vexatious delay of course 
occurred. The mayor and commissioner of health advised die common 
council, but the common council were not obliged to follow their advice 
under the law, and they took the matter into their own hands and made 
an attempt to settle the problem. 

In the meantime the commissioner of health was besieged on one side 
by a certain class of citizens to stop dumping the garbage into the lake, 
for fear of contaminating the water supply, and a continuous demand on 
the other side of all citizens to collect and remove their garbage. It was 
made a political matter, and the city had what will go down to history in 
city politics as the "Garbage Campaign of 1892." Finally the council 
adopted a resolution to send a committee, consisting of the mayor, city 
engineer, president of the common council, and the commissioner of 
health, to different cities to investigate the different methods of disposi- 
tion of garbage and to report with recommendations to the council. In 
February, 1892, this committee completed its work, but the council were 
not satisfied with that, and made a tour of investigation themselves, but 
finally returned, and adopted the reconmiendations made by the committee 
sent before. 

It was decided to let the contract for five years to a company who 
would build a plant foiuteen miles out of the city, collect and remove to 
said plant all garbage, offal, dead animals, both great and small, and 
animal matter of the city of Milwaukee, including refuse matter from 
commission houses, etc., to said plant, in which they would dispose of it 
in a sanitary manner, satisfactory to the mayor and commissioner of health. 

This contract went into effect, and the work was commenced in June, 
1892. The contract required that the company should collect this 
material under the supervision and control of the commissioner of health, 
and that at any time when the collection was imperfectly done, or the 
work of collection, transportation, or at the plant, was not conducted in a 
sanitary manner, the commissioner of health should have power to dis- 
charge men and demand competent ones put in their places, or to refuse 
payment for work done which was not satisfactory. 

The material should be collected in steel, air-tight tanks, and con- 
veyed to the plant without creating any offence or nuisance. Said 
collections to be made from residences three times per week in summer 
and twice per week in winter and from hotels and restaurants daily, and 
oftener if required by the conmiissioner of health, and that dead animals 
should be removed at once as soon as the company was notified of 
their whereabouts ; the company to provide two extra wagons to be ready 
for urgent calls at any time, and stationed near the health department 

The company shoidd transport this material to the plant either by boat 
or on cars, the station for loading to be approved by the commissioner of 
health* 



52 DISPOSITION OF GARBAGE IN MILWAUKEE. 

The city was to pay the company for the collection, transportation^ and 
disposal of this material the sum of $68,000 for the first year, with an 
increase of $2,000 per year to the end of the five years, at which time the 
city can enter into a new contract with the company, or purchase the 
entire outfit of the company, including the plant, teams, and transporta- 
tion facilities at a price to be fixed by arbitration, one arbitrator to be 
appointed by the city, one by the company, and the third by the other 
two arbitrators. 

The company constructed a plant at an expense of some $iio,ooo. 
They purchased a powerful steam ba^e for transportation ; they put 
on fifty steel, air-tight wagon tanks for collection and two large covered 
wagons for the collection of large dead animals. Garbage is collected 
between the hours of 4 a. m. and 12 m., and the boat leaves with its 
cargo for the plant at 1 o'clock p. m. daily, returning the same evening, 
to be ready for service by the collectors the next morning. 

Since the first of September, 1892, the plant has been in operation to 
the satisfaction of the city officials of Milwaukee, creating no nuisance or 
stench whatever that can be reasonably objected to in its location, and 
the collection and transportation of the material during that time has 
been fairly satisfactory. Any trouble arising from it has been traced 
mostly to the carelessness and negligence of collectors, in whose ranks it 
seems to be necessary to make changes now and then. 

From the commencement of the fuU operation of this plant in Septem- 
ber, 1892, to August 31st, 1893, one year, the company has collected and 
transported to the plant and disposed of 15,000 tons of garbage, averag- 
ing a little over forty-eight tons per day, counting twenty-six days in a 
month ; 15,943 small dead animals and 660 dead horses. 

The relief to a city the size of Milwaukee, in having this vast amount 
of refuse disposed of, can better be understood by sanitarians than by 
anyone else, and comment thereon is unnecessary before this assembly. 

There is one very important feature, from a sanitary standpoint, in 
connection with the disposition of this material, and that is that a process 
which utilizes the material or converts it into merchantable products 
encourages the managers to collect all of the garbage they can find, for 
the more they get, the more profit there is in their business. And the 
economic point of any process, which can save and not destroy, is 
self-evident to anyone who gives the matter any thought. 

The cost to the citizens in collecting, transporting, and disposing of 
this material seems at first sight to be large, but when one learns by 
figures that the cost of having this material promptly removed, taken out 
of the city, and disposed of in a sanitary way, is only a trifle over twenty- 
six cents per capita per annum, any charge against heavy expense in 
accomplishing this result would, I am sure, in the mind of any sanitarian 
drop into insignificance. 



XIII. 

THE DISPOSAL OF THE GARBAGE AND WASTE OF THE 
WORLD'S COLUMBIAN EXPOSITION. 

By W. F. morse, 
New York CUy. 

Two years since the report presented by the committee on the disposal 
of garbage and refuse before this association gave a clear idea of all the 
methods then in use for the disposal of city waste. Since that time the 
progress of destruction by fire has been by far greater than has been the 
employment of other devices. It is the purpose of this paper to briefly 
state what has been added to our knowledge on the subject, with special 
reference to the disposal by fire of the organic waste and garbage of the 
World's Columbian Exposition. 

Total destruction by fire of dty waste has been proved by six years ex- 
perience to be of great service in this country. So far as reports can be 
obtained, none of the garbage furnaces in use two years ago have been 
abandoned ; but on the contrary, the number has nearly doubled. New 
forms of destructors have been brought forward for experiment; novel 
ways of employing fuels are on trial ; the utilization of the heat produce4 
for obtaining power is found to be practicable ; more convenient means 
for handling die material are used ; the cost of operation is considerably 
reduced, and a general survey of the whole field shows a decided advance 
both in the number of furnaces constructed and their ability to perform 
the work required. 

In Great Britain a still more rapid advance has been observed. From 
an exhaustive report to the city council of Edinburgh, made by a special 
committee, a paragraph may be quoted : "There are now more than 310 
ceU destructors in use throughout the principal English towns, consuming 
2,000 tons of refuse per day at a cost varying from two and a halE pence 
per ton at Bolton, to three and a halE pence at Southampton ; nine pence 
at Ealing and Leicester to one shilling at Derby, and one shilling three 
pence at Winchester." It has been stated by competent authority that 
the present year there would be built in England one hundred more cell 
destructors, dealing with 250,000 tons of refuse per year. Thus, in Great 
Britain the process of destruction or disposal of town waste by fire has 
become a necessary part of the municipal sanitary work. No other new 
methods or devices appear to have been brought into use. There is a 
notable absence of the mention of any form of utilization of waste until 
the purification by fire has been first made. 



54 DISPOSAL OP GARBAGE OP THE EXPOSITION. 

Here at home there has been manifested a deep interest in this ques- 
tion ; many cities and towns have sent out commissions for inquiry and 
examinations at places where various furnaces and process metliods are 
employed, resulting in reports and recommendations for the erection of 
garbage furnaces. The individual yearly offidal reports of health officers 
have, in a great number of instances, included a concise description of 
garbage cremators, with estimates of cost of construction and operation^ 
urging upon the attention of the city authorities the adoption of this form 
of waste disposal. 

Perhaps the most instructive example of the disposal of waste by fire 
has been the work done for the past five months at the World's Columbian 
Exposition, and which is now going on, affording an opportunity for a 
personal inspection of the value and sanitary usefulness of this means of 
getting rid of the ^ sins of the people ". 

When the plans for the World's Columbian Exposition were completed, 
and it was known that six hundred acres of the ground would be occupied, 
that a considerable part would be used as the permanent residence of 
persons who would be constantiy on the grounds, and that for six months 
the buildings would be thronged by a vast multitude, it became evident 
that the sanitary care of this extent of ground and its inhabitants, was one 
of the most serious questions before the administration. 

Given a residentisd population of 15 to 20,000 and a daily average of 
150 to 200,000 additional visitors, it was estimated that the excreta, garb- 
age, refuse and waste of every kind that must result from their presence, 
would be nearly one hundred tons per day, all of which must be coUected 
and disposed of within the bounds of the Exposition, there being no Inti- 
mate outlet on land or water for such a purpose. 

It is doubtful in the history of this or any other country whether there 
has ever been a sanitary problem of equal magnitude which must be solved 
in the short time allowed, or which demanded a more safe and scientific 
solution than was the one here presented. To make a failure was to im- 
peril the fortunes of the great enterprise, while a success meant not only 
absolute protection for health, but the comfort, well-being, and convenience 
of a great multitude of people. 

After the adoption by the Exposition of the '^ Shone hydro-pneumatic 
system of sewerage ", the question of the final disposal of the product of 
the sewage sludge and the coUection and disposition of the waste and 
garbage was considered. An exhaustive examination of all methods in 
use was made by the engineer in charge of the sewerage and water supply 
of the Exposition, Mr. W. S. MacHarg of Chicago, resulting in the adop- 
tion of the Engle system of destruction by fire. 

A contract was entered into with the Exposition authorities by the En- 
gle Sanitary & Cremation Company of Des Moines, Iowa, and New York 
dty, by which the construction of two garbage furnaces to destroy the 
sewage sludge, garbage, stable refuse, and miscellaneous combustible 
waste, was guaranteed by the company. The location assigned was a lot 



DISPOSAL OF GARBAGE OF THE EXPOSITION. 55 

150 z 75 feet in the extreme south-easterly part of the grounds, near gate 
No. 6, and within a short distance of the Anthropological Building, the 
Forestry Exhibit, and near to the sewage cleansing works, and here were 
built two Engle garbage cremators, placed together longitudinally, with a 
brick stack fifty feet high. 

The details of construction of the Engle furnaces have been printed at 
length in the Proceedings of the American Public Health Association, and 
it will at this time be sufficient to summarise this for the benefit of those 
who may not have seen or do not recall the description. The cremators, 
including the stack and brick-work connecting with the furnaces, are 
45 1-2 feet long, 17 1-2 feet wide, and 12 1-2 feet high, exterior dimen- 
sions. On each side are platforms 2 1 1-2 feet wide by 57 feet long, reached 
by an inclined approach of ioq feet The covering house is 35 feet 
square, of corrugated iron. There are large sliding doors on two sides, 
through which the garbage carts discharge their loads upon iron slopes 
leading from the platform down to the feeding-holes of the furnaces. 
There are two of these slopes which are 20 x 10 feet, and have a storage 
capacity of ten tons each. The garbage dumped from the carts passes 
down the slopes into the feeding-holes, of which there are four for each 
furnace, one being large enough to receive the carcass of a horse. It falls 
upon the transverse grate bars in the upper or main combustion chamber. 
Hiese bars are made of interlocked fire-clay moulded blocks firmly keyed 
together, with spaces through which the ashes fall into the lower chamber. 
The fires are at each end of the upper chamber — one being above and 
the other below the level of the grates. The main or primary fire is by 
the action of the draught brought directly oyer and through the material 
on the grates, driving the smoke odors and gases the length of the cham- 
ber and downward into the flame from the second fire. This perfected 
and complete combustion fills the lower chamber and space beneath the 
grate, and passes on its way over bridge walls to a second combustion 
chamber, and finally into the base of the chimney. Every particle of car- 
bon, vapors, gases, and smoke is annihilated or transformed into carbonic 
add gas, that is discharged at a temperature of 1,000 degrees at the top 
of the chimney, a thin, colorless, invisible gas, which is immediately dissi- 
pated. Of aU the chimneys and smoke stacks within the grounds, there 
is none which shows so little signs of burning fuel as does this one. Con- 
nected with the interior of the combustion chambers are inlets which 
bring hot air from small chambers over the fire-boxes, to which the oxygen 
is admitted from the outside and heated to a high temperature. Hollow 
arches over the top, air spaces in the sides, and hot air pipes from the chim- 
ney also assist in furnishing heated air for the combustion of the garbage. 

The distinguishing feature of the Engle system is the use of the second 
fire, destroying the products of combustion from the material burned, and 
utilizing the heat thus obtained within the furnace. In the destructors 
employed in England this is accomplished by a secondary fire, called a 
''fume cremator," placed near the base of the chimney, the heat from 



S6 DISPOSAL OF GARBAGE OF THE EXPOSITION, 

which cannot be utilized. Before the introduction of this device their 
chimneys emitted smoke and offensive odors. The fuel used at the Ex- 
position furnaces is crude petroleum. This is brought by pipe lines 
directly from the oil fields in Indiana to tanks within the grounds, from 
which it is pumped into a stand pipe, 30 feet high,suppl3ring all the power 
plants of the Exposition. To atomize the oil, power is obtained by a 
twelve Kilowatt electric motor which drives a Root blower, giving an aver- 
age pressure of twelve ounces of air per square inch of opening. The 
form of burner used is the " S. C. T. Burner," atomizing by air alone, 
using no steam. This burner, a late invention of Messrs. Squire, Cobb 
& Tow], is largely employed by the Standard OU Co., in its pumping sta- 
tions, and is the only example of its type in use at the Exposition. By an 
accurate test, made by weight and measure of the oil, it is determined that 
under usual conditions, there is used from 5 to 7 gallons of oil per hour 
by each burner; three burners being usually run in each furnace, the 
maximum amount of oil required would be from 30 to 42 gallons per houri 
but this is greatly reduced during the latter part of the work, when the 
radiated heat of the furnace being very great, less fuel is required. 

There is brought to the cremators at 10 a. m., from eight to fifteen, the 
average quantity being about ten, tons of sewage cake from the sewerage 
cleaning station. By the "• Shone " system all the sewage from the grounds 
is forced by compressed air into large receiving tanks at the cleansing 
station, being about two and a half million gallons daily. After treatment 
with chemicals and the precipitation of solids to the bottom of the receiv- 
ing tanks, the effluent is run off into the lake, and the residuum pumped 
into sewage presses and formed into sludge cakes two and a half feet in 
diameter, and one to one and a half inches thick. 

These cakes come directly from the presses to the furnaces, being 
broken up into fragments in their transfer by carts. An analysis of this 
sludge gives moisture 58 per cent, and dry matter 42 per cent Of this 
dry matter there is about 18 per cent, of combustible material, being six 
to eight parts of oily or soapy material, and ten to twelve of paper pulp 
and foecal waste, the remainder being ash, lime, earth, and chemical and 
mineral products. Thus, only eighteen percentage of the original sewage 
bulk can be actually burned. When exposed to high temperatures in this 
semi-fluid, viscous condition, the liquids slowly evaporate and the residuum 
falls in a yellow, powdery ash. It does not bum, as there is so small a 
percentage which fire can take hold of, but transforms to a condition like 
burned day or earth. The ash remaining is far greater in quantity than 
from an equal amount of garbage. The process is slower, actual results 
showing that twenty-four tons of garbage can be burned at a lower tem- 
perature in the time required by eight tons of sludge at a far higher heat. 

The daily collection of garbage begins at 11 o'clock at night, and con- 
tinues until morning. The carts used are those known as the '< Hill " 
garbage wagon, a light, water-tight iron body on two wheels, holding 45 
cubic feet, with a projecting tail-board allowing the discharge of the con- 



DISPOSAL OF GARBAGE OF THE EXPOSITION, 57 

tents free from the wheels. They are drawn by one horse and attended 
hy one man. 

The garbage comes from the kitchens of the national and state build- 
ings, restaurants, the native villages, and often contains large amounts of 
<:oal ashes. There is no paper, sweepings, or combustible refuse, and but 
small quantity of excreta from earth closets and vaults. There have been 
burned the bodies of two camels, four horses, two cows, two deer, one 
elk, several dogs, and smaller animals. These pass into the upper com- 
bustion chamber through the large feeding hole, no preliminary cutting 
being necessary. The body of the largest horse was consumed in an 
hour ; the smaller animals in much less time. There was no visible dis- 
charge from the chimney during their combustion. The mixture of coal 
ashes with garbage, which has sometimes been as much as twenty-five per 
cent, of ash, delays the process of combustion, requiring more time and 
labor to pass it through the grates, but 49es not otherwise affect the oper- 
ation of the furnaces. The quantity of liquids contained in the garbage 
is very large. After rains there is always a great increase in this ; fre- 
quently the carts discharge one third more of their contents in water. 

There are required three shifts, of four men each, for the twenty-four 
hours, which, with two engineers and superintendent, make fifteen per- 
sons employed in the management of the furnaces. Because of their 
peculiar situation, and the fact that the furnaces must alwa3rs be ready for 
public inspection, a larger force is employed than would otherwise be 
necessary for the work. The greater proportion of the work is done be- 
tween the hours of twelve o'clock midnight and twelve o'clock noon. It 
could be all done in the six hours from 12 to 6 o'clock, a. m., if the col- 
lection could be brought to the furnaces more promptly. The cost of 
operation and maintenance, including the cost of fuel, is as nearly as can 
be reckoned, sixty to seventy cents per ton. This is larger than has been 
done at some other of the E^gle furnaces, because of the exceedingly re- 
fractory character of the sludge destroyed. As before stated, it takes 
much more heat and labor to destroy the sewage sludge than it does a 
quantity of garbage three times its bulk, and the product of ashes and 
consequent labor from the combustion of this is very largely increased. If 
the ordinary and usual collection of garbage of a city, say for instance, 
Chicago, were to be destroyed by this process, and the work carried on by 
private contractors, or by strict oversight on the part of city authorities, it 
is certain that the cost of operation would be considerably reduced. It is 
safe to say that 50 cents per ton would represent the cost for this class of 
garbage. Where the garbage includes the miscellaneous combustible 
refuse of the dty, the cost of combustion is still further lessened, as every 
particle of combustible matter aids in consuming the wet material. For 
instance, at the dty of Savannah, Ga., where there have been two Engle 
garbage cremators in use for the past four years, the official report of the 
operation of these furnaces from January ist to September ist, 1893, is 
as follows : 



58 DISPOSAL OF GARBAGE OF THE EXPOSITION. 

Garbage loads, I4»932 

Cubic yards, 37.955 

Cows, 97 

Horses, 155 

Goats, 30 

Dogs, 1,650 

Cats, 2,768 

Fish, 55 bbls. 

Meats, 7,675 lbs. 

Poultry, 10,643 h^- 

Onions, 23 bbls. 

Oranges, 36 Ids. 

Bananas, 31 Ids. 

Apples, 5 bbls. 

Infected goods, 651 pieces 

Average amount burned daily, • 158 15-100 cu. yds. 
Average loads hauled daily, 62 20-100 

The cost for destroying the 37,955 cu. yds. is $4,457.21, at a net cost of 
II 1^ cents per yd. 

This does not include horses, cows, etc., which are burned in the cre- 
mators — this is garbage only. 

It is difficult to estimate this quantity by weight, as it includes a large 
proportion of combustible refuse and a considerable amount of the con- 
tents of privy vaults. During the year 1892 the average cost per cu. yd. 
for fuel and labor at this city (Savannah) was 13 cents. As it will be 
seen, the addition to the city garbage proper of combustible refuse tends 
not only to provide means for the disposal of worthless matter, but ta 
diminish the cost of maintenance of the furnace which destroys the offen- 
sive kitchen offal. This record is still further strengthened by reports of 
a similar character from the cities of Norfolk, Va., Richmond, Va., Jack- 
sonville, Panama, Salt Lake City and Ogden, Utah, Des Moines, la., 
Findlay, O., and many other cities where these furnaces are in use. 

The ashes from the destruction of garbage at the Exposition accumu- 
late in a pile outside the house, and are used by the authorities of the 
Exposition in filling such parts of the grounds as had to be brought up to 
grade. No effort has been made to utilize them for any purpose of fer- 
tilization, but they possess undoubted value as they contain from at least 
four to six per cent of potash and a small percentage of phosphoric acid. 
Repeated analyses of the products of garbage combustion have shown that 
there is nearly enough value in these ashes, if properly separated from the 
debris, to very nearly pay for the fuel used in the operation of burning. 
When used for filling low grounds or making streets, they are more valu- 
able than the same amount of earth or gravel. On sandy roads these 
ashes, packed solidly, do not break up imder the wheels, and make an 
elastic and firm track. 

The destruction of the garbage of the Exposition has been continuously 
performed since the ninth of May, when the one furnace went into opera- 



DISPOSAL OP GARBAGE OP THE EXPOSITION. 59 

tion. There has been no cessation, the daily coUection being delivered 
and disposed of with the utmost rapidity consistent with the sanitary per- 
formance of the work, the object being to keep the grounds free from 
waste, and to care for the sewage sludge as fast as produced, so that no 
ofifence shall arise, and there need be no large accumulation on hand- 
This has been perfectly accomplished, and had it been possible to secure 
a perfectly trained body of men to operate the furnaces, so that experienced 
help would be sure of being had at all times, the work of operation would 
have been much simplified. The men who have been assisting in the 
work have been constantly changed, and it [is difficult to get and retain 
reliable men to operate them. Taking the work of these garbage crema- 
tors as a whole, considering the difficulties under which they we recon- 
structed, the limited extent of time for which they would be employed^ 
the exceedingly refractory character of the waste to be consumed, and the 
difficulties incident to the construction, management, and superintendence 
of the work, the results accomplished have certainly been remarkably suc- 
cessful. 

It must be remembered that this destruction is performed under the ob- 
servation of men experienced in furnace construction ; engineers perfectly 
familiar with all the details of application of heat and power, experts who 
are responsible for the cleanly condition, good health, and comfort of great 
multitudes of people, and is inspected by thousands of persons interested 
in examining for sanitary reasons the destruction of waste where the 
slightest sanitary anno3rance would be instantly observed and commented 
upon. To have done this work five months to the entire satisfaction of 
the board of administration and the sanitary engineers of the Exposition, 
is a most striking and conclusive evidence of the value of garbage crema- 
tion, and of the usefulness of the Engle system when brought into use on 
a la^e scale. It is evident that the same work could be performed else- 
where, imder conditions which could hardly be more exacting, with equal 
success. 

There remains in this connection only one thing more to be noted : In. 
most cities throughout the United States the collection service, whether 
by contract or by municipal work, collects] and transports all the waste of 
the city in one receptacle. In but comparatively few places is the separa- 
tion made of putrescible garbage, combustible waste, and ashes. The result 
is an aggregation of material which cannot be destroyed in its original 
state, which is difficult to separate satisfactorily, and which is entirely 
worthless, from the admixture of putrescible matter, which permeates the 
whole. 

The next step demands an apparatus which shall take this material and 
prepare it for cremation, separating the valuable parts and destroying the 
rest It is entirely practical to so arrange a series of screens, sieves, or 
separative machinery, which shall take the mixed garbage, ashes, etc., re- 
move the finer portions of ash, separate the paper, leather, glass, iron, rags, 
and discharge the residuum into the mouth of the furnace where it is 



6o DISPOSAL OF GARBAGE OF THE EXPOSITION. 

destroyed The material -which is of some value, and which is by this 
process sorted out, would then be disinfected by steam heat, cleaned and 
prepared for sale, and the revenue therefrom placed to the credit of the 
city. If the city of New York can receive $93,000 each year for the priv- 
ilege of picking over the garbage as it is discharged on the decks of the 
scows, and if the parties holding this contract can make a large sum of 
money by this crude, imperfect system of handling this material, it is quite 
certain that if the work were carried on in a systematic manner, a great 
deal larger revenue would be produced. What is true of New York is 
true to a greater or less extent in every city of the country. There is to- 
day hauled out and put upon the dumps, cast overboard, or discharged 
into garbage cremators, valuable material enough to defray 25 per cent, of 
the cost of the collection service in every place. Under the American 
system of wasteful living there is thrown out from the households a large 
proportion of food products, which would be reckoned valuable abroad. 
Under the somewhat lax and irresponsible methods of municipal business 
conducted by conmiittees and councilmen of this country, there is less at- 
tention paid to the economical operation of garbage disposal methods than 
should be done ; the result is the destruction yearly of a great mass of 
valuable waste, which should be saved at a profit to the city. 

Another thing : the heat caused by the destruction of putrescible waste 
can be perfectly well applied for the production of power, which in its 
turn is used for municipal purposes. There goes up the chimney of every 
garbage cremator in the country, heat enough to run a steam boiler of fif- 
teen to forty horse-power. When these garbage destroyers are built as 
they should be, — ^in connection with other municipal plants where steam is 
employed — ^the cost of operation would be greatly diminished, and the 
necessity of doing the work cleanly and economically will become much 
more apparent. Our English brethren have made greater progress in this 
direction than has been done in this country. Their destructors in some 
cases are self-supporting, from the fact that everything of value is utilized, 
and the heat is turned into active power. The day will come in this coun- 
try when this will be as much a part of the disposal system as is the con- 
struction of the furnaces themselves. 

THE DISPOSAL OF EXCRETA 

without the intervention of conveyance by sewers, is accomplished by the 
operation of a small << fire closet," which has been constructed, and is at 
work at the side of the "garbage cremators" at the World's Exposition. 
This shows by a small working model what might be done on a larger 
scale in every school-house, public building, or manufacturing establish- 
ment where no drainage can be secured, and where the necessity for the 
disposal of the organic waste is evident. Proceeding upon the same plan 
of employing two fires, the one disposing of the excreta, and the other the 
products of that combustion, the excreta is received upon the grate-bars, 



DISPOSAL OF GARBAGE OF THE EXPOSITION, 6l 

the liquid portion passing into the pan underneath, and at the proper time 
is destroyed by the application of fire in the two fire-boxes. The amount 
of fuel is insignificant, the time required very short, and the operation of 
destruction inoffensive, unobjectionable, and sanitary. This device has 
been employed in this country for six years, has been found to be a per- 
fectly sanitary substitute for all privy vaults, system of water-carriage or 
earth-dosets, and is susceptible of being applied at every place where the 
conditions do not warrant the conveyance of household excreta by drain- 
age. This apparatus will repay a strict investigation, and will demonstrate 
its usefulness under all conditions. 

A recapitulation of the work done at the Exposition up to date may be 
of interest, though it is necessarily incomplete. 

For the five months that the cremators have been used there was about 
5,732 tons of sewage cake and garbage brought to the furnaces ; also a 
considerable amount of stable refuse and damaged food products, besides 
the bodies of 12 large animals. The average weight of a load of sludge 
cake was found to be 2,700 lbs., and of a load of garbage 2,035 ^^' ^^ 
these calculations, the weight of sludge is assumed at 2,400 lbs., and of 
garbage at one ton, except in the middle of summer, when this was slight- 
ly larger. 

The largest quantity of oil burned in one hour was 716-7 gals., used by 
six burners, the average of 8 days' test, being 37 1-2 gallons per hour, or 
6 1-3 gallons for one burner per hoiu^. 

One day's trial, during which time the oil, sludge, and garbage were ac- 
curately weighed, showed there was destroyed 8 i-io tons sludge cake, 
27 1-4 tons of garbage mixed with large quantities of liquid, the time re- 
quired being nine hours for the sewage cake and twelve hours for the 
garbage. 

There was burned 895 gallons oil for fuel. The labor employed ex- 
tended over the 24 hours, the relative proportions of expense for fuel and 
labor being about 75 1-2 cents for sludge, 67 1-2 for garbage, per ton. 

Taking the cost for fuel and labor during the time the furnaces were 
actually operating, the expense would be considerably reduced, the in- 
creased cost being due to the peculiar conditions of night collection of 
garbage, the necessity for quickly destroying it, and the lapse of time be- 
fore the sewage cakes are received. 

The largest day's work done was the disposal of 21 3-4 tons of sewage 
cake, and 38 1-4 tons of garbage, the time required being about 18 hours, 
at a cost for fuel and labor of 60 cents per ton. 

Finally, it will be seen that the disposal of city waste by fire can be 
carried on in the immediate vicinity of dwellings without nuisance or of- 
fence, provided the work be done by furnaces adapted to the purpose, and 
operated by men who are competent. It is demonstrated that not only 
garbage, refuse, and dead animals, but also sewage sludge and excreta, 
can be perfectly destroyed when required. It has been shown that the 



62 DISPOSAL OF GARBAGE OF THE EXPOSITION. 

cost of doing this work is as reasonable as can be expected, considering 
the difficulties which are to be encountered, and that this cost is steadily 
being reduced, as the character of the work becomes better understood, 
and the furnaces are constructed on more scientific plans. It must be 
evident that a great saving can be made by separating such valuable parts 
of city waste that can be sold, and thus diminish the cost of operation, 
and it is sure that the progress made in the direction of waste disposal by 
fire, far outstrips and exceeds all other methods or means which have 
been developed since the meeting of this association held two years since. 



XIV. 

NATIONAL REGISTRATION A NECESSITY. 

By S. W. ABBOTT, M. D., 

Skcrstary State Board op Hkalth of Massachusetts, 

Boston, Mass. 

In the present paper it is my design to state briefly some of the reasons 
for the adoption of a system of registration of vital statistics in each one 
of the United States ; such a system as now exists in nearly every enlight- 
ened nation, the United States, as a whole, forming a marked exception. 

Dr. Curtis, in a very intelligent discussion of the general subject of vital 
statistics, says : " A full and accurate knowledge of the people in every 
community is an indispensable requisite for the successful administration 
of public affairs. Such knowledge is obtained by the public authorities 
from two distinct sources. In the first place, the enumeration of the peo- 
ple, by which the population, the numbers, the ages, the abodes, the pro- 
fessions, etc., of the individuals composing it are ascertained, is effected 
by the taking of a census. In the second place, ' the movement of the 
population,' under which term are comprehended the births, marriages, 
and deaths occurring yearly, is determined by registration." (Buck's 
Hygiene, vol. ii, p. 302.) 

Dr. Ogle states the objects of the registration as follows : ^ ''(i) There 
are all the legal uses, where proof of death is required, such as the suc- 
cession of property, pa3rment of insurance monies after death, etc. ; (2) 
there is the prevention o^ or interference with, murder, or foul play gen- 
erally ; (3) the provision of trustworthy data for the elaboration of statis- 
tics concerning health, disease, and mortality." 

The purposes of registration are manifold, and their importance em- 
phasizes the necessity of having this department of statistical work con- 
ducted in the most thorough and intelligent manner. 

It serves in the first place to facilitate the identification of individuals 
for the transmission of property, and for the protection of life against 
crime. 

Secondly y it affords data for the determination of life contingencies, 
which form the bases of life insurance. Sufficient importance has never 
been given to this use of the statistics of mortality in this country. The 
figures upon which this very great and important business, (amounting to 
many millions in each year, and affording protection reckoned even by 

^ ETideoce before the Parliamentary Committee on Death Certification, Jane 3, 1893. 



64 NATIONAL REGISTRATION A NECESSITY, 

billions), is founded, can only be obtained in this country from a very small 
portion of the people having registration extending over a long period of 
years. 

But thirdly^ the most important of all, it furnishes to sanitary science, 
and to the medical profession in general, most valuable information re- 
garding the public health. The mathematics of public health is the actual 
basis on which all exact knowledge of sanitary progress is founded. 

With these facts in view, it is a sad comment upon the civilization of a 
great nation, that 65,000,000 of people are to-day entirely without any 
general system of registration of vital statistics ; that the birth-rate, the 
death-rate, and the marriage-rate of this country, as a whole, are absolutely 
unknown. 

There is no information to be had, for example, as to the birth-rate or 
the death-rate of this great state of Illinois, within whose limits we are 
assembled, the third state of the Union in its population of more than 
four millions. We have absolutely no means of comparing the death-rate 
of Chicago with that of the rural population of the remainder of the state ; 
since, while the former is known with some degree of certainty, the latter 
is unknown. There is no means of comparing the death-rates of any of 
the counties of the state (or of larger districts) with each other. 

Of the foreign countries, most of the largest and enlightened nations of 
Europe have had registration, of a more or less complete character, for 
periods varying from a quarter to a half century or more. It is a matter 
of great importance in the study of nations that their conditions and cir- 
cumstances may be compared with each other. But in this very important 
direction we, as a nation, have no possible means of making such a com- 
parison. When individual states are considered, we find a little improve- 
ment. States embracing about 12 per cent, of the population of the whole 
country have fairly complete S3rstems of registration, while other states 
having about as many more inhabitants, have enacted adequate laws, but 
thus far the execution of these laws is not fully carried out. 

What then is needed to introduce and to perfect a thorough system of 
registration throughout the whole country, from Maine to Alaska, and 
from the gulf to the great lakes ? 

1. The enactment of laws in every state providing for the registration 
of births, marriages, and deaths. The more uniform such laws can be 
made, with reference to the information to be obtained in individual cer- 
tificates, the better. 

2. The cordial co-operation of the general government in providing a 
central authority for the collection and publication of the statistical ma- 
terial of the individual states. Possibly grants might be made to the 
younger states to facilitate the introduction of this very important work. 

3. The necessity of awakening the interest of the medical profession 
in this work, and the need of their hearty co-operation in aiding it in 
every possible manner, is apparent. To this end the raising of the stand- 
ard of medical education unll have a favorable effect. The teaching of 



NATIONAL REGISTRATION A NECESSITY. 65 

vital statistics as an essential part of medical, and especially of sanitary, 
education should be insisted upon. 

41 The placing of the work of registration in the hands of trained medical 
men, who should act as r^strars. These should not only be medical 
men, but also men who are experts in the subject of vital statistics at 
least. This principle is recognized by all the foremost authorities in pub- 
lic hygiene. No one doubts, for a moment, the wisdom of the British 
government in entrusting the r^stration of England to such men as Dr. 
Farr and Dr. Ogle. And the same may also be said of the French and 
German governments. Due authority should be given to the registrars of 
states and of municipalities to examine the returns of death carefully, and 
to institute inquiries in all doubtful cases, especially when the certificates 
are signed by unqualified practitioners. 

5. In addition to the foregoing considerations, a revision of the nomen- 
clature and classification of diseases is demanded, which shall be in har- 
mony with the progress of medical science. Such revision, whenever it 
shall be made, should be uniform throughout all countries having regis- 
tration, in order to facilitate the international comparison of the results 
obtained by registration. ( See Transactions of Mass. Med. Society, 1892.) 

While the accurate registration of all deaths embraced under the five 
general divisions or classes of disease is desirable, there is one class 
which has a peculiar interest to the sanitarian, and that is the group of 
infectious diseases, or those to which for a half century the name '' z3rmotic" 
has been applied. The diseases of this class, or at least a majority of 
them, are undoubtedly amenable to those preventive measures which con- 
stitute a large share of the work of sanitary authorities. Hence all such 
authorities must necessarily recognize the great importance of having a 
definite knowledge as to the mortality from infectious diseases from 
month to month and from year to year. Such knowledge can only be 
had under a careful system of registration thoroughly carried out. 

To this class of diseases belong typhoid fever and phthisis^ ; diseases 
which destroy life during its most productive period, and hence involve a 
great economic loss to the population. The steady decline in the mortal- 
ity from these diseases in cities and towns having such municipal sanita- 
tion as is required, is too well recognized to require lengthy comment here. 
But without a good system of registration the question of improvement 
or of retrogression could not be known with any degree of certainty. 

Legislatures are slow to act when definite, tangible evidence, or state- 
ments, as to the actual results accomplished by sanitation, are not to be 
had. Hence the importance of establishing such thorough and complete 
systems of r^stration as shall furnish the desired information. 

The relation of the vital statistics of any community to the public health 
administration of that community is very much like the relation which the 
counting-house of any commercial firm bears to its business. The busi- 
ness may be great or small ; it may conduct commercial transactions over 

iBy almost universal consent phthisis should be included in the category of infectious diseases. 



66 NATIONAL REGISTRATION A NECESSITY. 

a very large extent of territory. It may own property, factories, or mills^ 
in different manufacturing towns ; it may employ large or small numbers 
of workmen ; but, if it is desirable to obtain any definite information as to 
the extent or character of its operations, their success or failure, one must 
go to the counting-house or to the business office if he wishes to obtain 
accurate information as to the standing of the firm, its amount of business, 
and the character of its operations. The assets and liabilities of the firm 
are here matters of record, and its journal and ledger, its daily, weekly, 
monthly, and yearly balance sheets, tell us of the actual condition of its 
business. 

Applying this illustration to the operations of a sanitary authority, the 
vital statistics of any community tell us its actual progress or retrogression 
in the excess of births over deaths, or vice versa, of deaths over births. 
The changes, too, in death-rates from preventable diseases, both individu- 
ally and collectively, are instructive, as showing to a certain extent the re- 
sults of thorough and efficient sanitary work. They constitute the sanitary 
barometer by which, not only present conditions are known, but also, with 
some degree of certainty, future conditions may be foretold. 

Let the following facts serve as an illustration : 

Upon a comparatively large river in my own state are some half-dozen 
manufacturing cities and towns. Let these cities and towns be represent- 
ed as follows : A, the cities and small towns upon the upper portion of 
the stream (embracing 300,000 inhabitants) ; B and C, two larger cities 
upon the lower portion of the same stream ; D, a smaller city near its 
mouth. The entire population upon the water-shed of this river is about 
a half-million inhabitants. 

The State Board of Health collects information weekly from the cities 
and towns within the limits of the state, as to the mortality from infectious 
diseases, including the cities and towns upon this river. It is also 
authorized by law to examine all the water-supplies of the state, a work 
in which it js continually engaged. The statutes forbid that streams used 
as water-supplies shall be used for the discharge of sewage, but the river 
in question is exempted by law from the operation of this statute, and 
sewage goes into it without hindrance from A, B, C, and D. Now B and C 
take the water of this river directly, and without filtration, for domestic 
use. Sewage from A enters the water-supply of B ; sewage from A and B 
enters the water-supply of C. As might be expected, under the condition 
of affairs, typhoid fever has become more than epidemic at B and C ; the 
mortality from this cause bearing the following ratios for the twenty years 
(1871 to 1890): 

The typhoid death-rate of the state being taken as 100, that of B was 
155 and that of C was 170, while in the past five years of this period the 
excess-rate was still greater. Any slight prevalence of typhoid fever in 
the sewered portions of cities and towns included in A was pretty sure to 
be followed by a greatly increased prevalence in B and C. 

Up to the fall of 1892 the water-supply of the small city D was not taken 



NATIONAL REGISTRATION A NECESSITY, &J 

from the river, but from a spring upon its shore. During the dry season 
of 1892 this spring became inadequate, and the water-supply, which was 
furnished by a private company, was increased by extending a water pipe 
to the river and supplementing the supply directly from that source. In 
the frequent routine examinations of the water-supplies conducted by the 
State Board of Health this fact became known to the board, in con- 
sequence of the immediate change in the quality of the water as shown by 
its analysis. Under these circumstances the board immediately warned 
the water company of the danger of using water from a constantly polluted 
stream into which the sewage of a population of several hundred thousand 
was discharged. The company took no notice of this communication, 
but continued pumping water from the river and distributing it to the in- 
habitants. What was the result ? In less than two months an epidemic 
of typhoid fever attacked the population using this water, more severe in 
character than had been known in that city for a half century. It so hap- 
pened that this event occurred during, or at the beginning of, the session 
of the state legislature. The citizens were soon aroused to a sense of 
the danger of the situation. The mayor appealed to the legislature for 
such aid as proper legislation might afford, and while the franchises of 
water companies have usually been guarded with jealous care, in this 
instance the flagrant disregard of the admonition which had been given 
them, and the consequent sickness and death of many citizens which 
might have been avoided had they not neglected the advice of an experi- 
enced authority which had thoroughly examined the whole situation, in- 
duced the legislature to give to the city the right to introduce an inde- 
pendent supply, and at the time of this writing (October, 1893,) the city 
has, by an overwhelming majority, voted to take this action. 

I have presented this illustration, not so much for the purpose of show- 
ing what might have been done in preventing sickness and loss of human 
life, under circumstances of careful observation, followed by advice to a 
responsible corporation, and an obedient following of such advice, but for 
the purpose of showing the usefulness of a careful system of vital statis- 
tics, embracing a weekly return from the cities and towns along the banks 
of this river, of the deaths and causes of death, by which a warning reaches 
the State Board of Health and may by it be transmitted to the local 
boards, of the existence of unusual prevalence of epidemic disease. 

About a quarter of a century ago the death-rate of England was con- 
stantly higher than it is at the present day. It was noticed that this high 
death-rate was mainly in the 'large towns and cities. Sanitary works were 
introduced in these cities, embracing new water-supplies, systems of sew- 
erage, and disposal of refuse, etc., and very soon the death-rate was dimin- 
ished in nearly every city in which such improvements had been intro- 
duced. (Ninth report of the Privy Council, England.) 

Now the point which I desire to enforce is not so much the fact of such 
improvement as a natural consequence of thorough sanitation, but the 
method by which this fact was ascertained. The foundation or basis 



68 NATIONAL REGISTRATION A NECESSITY, 

upon which the general public movement for these improvements rested, 
and which justified their introduction, was the death-rate of the cities in 
question. The computation of this death-rate, and the comparison of the 
mortality before and after the introduction of public sanitary improve- 
ments, was made possible only by the existence throu^out the whole 
country of a complete and accurate system of registration. 

Again : The possibility of conducting such valuable and instructive in- 
vestigations as are presented in Dr. Longstaff's ^' Studies in Statistics/' in 
Nelson's "Contributions to Vital Statistics," and in the older papers of Bu- 
chan and Mitchell, is only made certain by the existence of a system of 
registration. 

In this connection I desire to call your attention to one class of causes of 
death which is more or less preventable, although not in the same sense 
and degree as the group of infectious diseases ; I mean the class of deaths 
by violence. All measiures which tend to ameliorate the condition of 
man, to lessen suffering, poverty, and intemperance, to protect life and to 
make it more secure from danger, will thereby diminish the annual mor- 
tality from homicide, suicide, and accident. 

In the state of Massachusetts, by a statute of 1885, the registration of 
this class of deaths was made much more thorough and complete than it 
had previously been. At a still earlier date ( 1877 ) the coroner system 
had been abolished, as a useless relic of antiquity, and an entirely new 
method of inquiry was introduced, which was modelled after the better 
modes in operation in continental £urope. 

The new plan of procedure provides for the separation of the medical 
from the legal duties connected with the investigation of deaths by 
violence, the former being entrusted to a corps of well-trained medical ex- 
aminers, while the latter are performed by the district judges. The oper- 
ation of this system for a period of sixteen years has been entirely satis- 
factory. It is at once more economical and far more efficient than the 
coroner system, which it superseded, and no one at the present day desires 
to return to the old method. 

I would therefore commend this mode of investigation, together with 
the improved system of registration which now constitutes a part of the 
general plan, as suited to the wants of any community comprising either 
a large or a small population. 

To conclude : A thorough system of registration is not only a valuable 
auxiliary, but is a natural and essential department of the work of any 
general sanitary authority, and in every state where no provision is made 
for the collection, tabulation, and publication of the vital statistics of the 
population, measures should be taken, with the least possible delay, for the 
carrying out of this important public duty. 



XV. 

IMPORTANCE OF SANITARY BUREAUS; THEIR ECONOMIC 

ORGANISM. 

By Dr. J. E. MONJARAS, 
San LmU Potosi, Mexico, 

Since the science of hygiene has reached that point where' it is found 
to-day, the technique of its applications imposes, that the best ordinances 
and the most judicious measiures may lose their efficacy, when they are not 
applied with the requisites which they demand ; as, for instance, the failure 
of a sanitary notice, at the right time, might be the means of propagating 
an epidemic ; a disinfection performed with a few degrees less of heat than 
is required, or a few grains less of the disinfecting stuff, might bring the 
same result ; a person suffering from a transmissible illness might be the 
means of importing an epidemic should he not be properly isolated ; and 
this, again, may occur, if persons who visit the patient have not been disin- 
fected before putting themselves in relation with those persons in whose 
circle they associate. 

The failures in prophylactic measures have been observed to be due 
rather to the negligence of the technique than their lack of efficacy. 

The only way to avoid these failures can be secured by founding san- 
itary bureaus in every place where there is a gathering of individuals, 
equipping them with the authoritative and necessary power, so as to take 
care that the hygienic measures, ordained by law, are complied with on the 
public highways, at home, and by the individuals, by giving to them the 
necessary elements for testing the piuity of the nourishments, and the in- 
fectious matter of transmissible diseases, and finally, by furnishing them 
with the requisite pecuniary elements for the sanitation of the localities, 
that they may not have such conditions as may imperil the lives, and for 
obtaining in the statistics, which must be very weU organized, 15 per cent, 
of the annual mortality. 

The organization of these offices should consist of a consultative body, 
formed of the most distinguished persons of the locality in medicine, 
chemistry, engineering, plumbing, and commercial industries, and by an 
executive body, who would put in practice the hygienic measures as they 
are ordained by the law. The personnel of this latter body should vary 
according to the population of the locality. It will be comprised of a 
director and clerks under him, in the required number so as to fulfil in 
practice easily the sanitary ordinances. At the office, there should be a 



70 IMPORTANCE OF SANITARY BUREAUS. 

section where the sanitary notices may be received, and where the meas- 
ures emanating from them may be issued ; chemical and bacteriological 
laboratories, where the purity of the nourishments and the pathogenic mat- 
ter of microbes may be tested, and vaccine be prepared ; and lastly, a 
section should be held so as to secure periodically the census of the popu- 
lation, and obtain daily the necrological statistics. 

I ask then, of this honorable assembly, to approve the following resolu- 
tions: 

I St. That the delegates of the several nations here represented should 
petition to their respective governments to establish sanitary offices where- 
ever they do not exist to-day. 

2d. That the isolating and disinfecting measures may be practised by 
no others than the members of these offices. 

3d. That an international committee be appointed to study and deter- 
mine which is the best statistical form to adopt, having the same nomen- 
clature and a uniformity of proceedings in the formation of statistics. 

The committee secured, in lieu of the above, the creating of a com- 
mittee to be entitled, on nomenclatiure of diseases and form of statistics^ 
and that the old committee on forms of statistics be abolished. 



XVL 

OBJECTS OF THE NATIONAL HEALTH SOCIETY OF LONDON. 

By ERNEST HART, M. R. C. S., D. C. L., 

London, England. 

The National Health Society, which has been established over twenty 
years, owes its origin to the exertions of a few energetic and philanthropic 
ladies, who, realizing the vast importance of the well*known saying, '< Pre- 
vention is better than cure,'' set to work and banded themselves into a 
society for the advancement of sanitary laws. The greater part of disease 
and suffering arises from the total ignorance which exists with regard to 
these laws, more especially among the lower classes, who formerly were 
opposed to any attempt at reform in this direction. Great undertakings 
often spring from small beginnings ; probably few who knew the work of 
the National Health Society in its initial shape would ever have dreamt 
of the prominent position it would occupy amongst the leaders of sanitary 
reform in the present day. At first the ladies confined themselves to the 
modest work of organizing lectures at men's clubs and mothers' meetings, 
thus spreading abroad a little knowledge of vital laws and health. 

His Grace, the Duke of Westminster, ever a ready patron of all good 
works, consented to become president of the Society. H. R. H., the 
Princess Christian, H. R. H., the Princess Louise, the Duchess of Teck, 
the Duchess of Westminster, and many other aristocratic, influential ladies 
came forward as patronesses and vice-patronesses. A council and execu- 
tive committee were formed, numbering among its members the foremost 
medical, scientific, and philanthropic men of the day, and of which I 
have been the chairman for twenty years. The important office of secre- 
tary was ably filled by Miss Fay Lankester. Thus, step by step, stone by 
stone, the Society has been built up, its work organized, and its value 
made known all over England, until to-day it stands a striking example of 
what woman's energy and industry can achieve — having fitly earned its 
proud title of the National Health Society. 

The present offices of the Society are at 53 Bemers street, where large 
and beautifully fitted rooms have been decorated and furnished for the 
use of the secretary and her staff of ladies. Lectures are held in the 
committee room, where practical demonstrations are given by eminent 
surgeons and lecturers of both sexes on various subjects. 

These lectures are well attended by ladies anxious to qualify for the 
Society's certificate, which is awarded to all who pass successfully the 



72 NATIONAL HEALTH SOCIETY OF LONDON 

needful examinations held at the conclusion of the series. Lectures are 
given here on " First Aid to the Injured," " Nursing," and " Sanitation." 

Membership is constituted by the yearly pa3rment of the fee of one 
guinea, life membership by a fee of ten guineas. Members have the right 
of attendance at any of the above lectures, and are entitled to a free copy 
of all the Society's publications. 

The series of publications issued by the National Health Society in- 
clude many important leaflets and pamphlets on useful subjects, such as 
" Economical Cookery," "The Management of Infants," "The Care of the 
Sick," ** How to Prevent the Spread of Disease," "Vaccination," "How 
to Prevent and Oppose Cholera," "How to Choose a House," "Rrst 
Aid to the Injured," " The Management of the Sick-room," etc., etc. A 
diploma of honor was awarded to the Society for its valuable literature, 
by the Council of the International Health Exhibition. The useful 
almanac, with a sanitary motto for every day, and the cards for cooks, 
house-maids, and nurse-maids, with valuable advice " What to do till the 
doctor comes," should be hung up in every weU regulated house ^or the 
direction of heads of families and servants. 

The Society has now trained a large staff of lecturers, both men and 
women, who deliver theur lectures all over the country, in public halls, 
school-rooms, private drawing-rooms, and cottages. These lectures have 
been wonderfully appreciated by all classes ; more especially by the work- 
ing men and women, mothers, young girls and lads, district visitors, and 
even plumbers, etc. During the two last years the valuable work of the 
National Health Society has been recognized by the County Councils^ 
who have arranged courses of lectures in the various counties under their 
jurisdiction. The lecturers have been sent down to the towns and villages 
all over England, — indeed the difficulty is to secure sufficient ladies as lec- 
turers, so great is the growing demand for sanitary knowledge. In Devon- 
shire, Surrey, Norfolk, etc., these lectures have been more than usually 
successful. Each day Miss Lankester has demands for fresh courses of 
lectures, which involve considerable labor and organization, and expendi- 
ture of thought and time. 

The lectures to the poor are delivered free of charge, wherever a demand 
is made. To meet the expenses of these free lectures, subscriptions are 
furnished by a large body of earnest-minded people. The drawing-room 
lectures are equally popular, and are delivered at the houses of many of 
the leading members of society. 

In the year 1892 the Society held a successful Dress Exhibition, and in 
the previous year a Health Exhibition, dealing with such important sub- 
jects as " Smoke Abatement," " Removal of Dust," " Instruction of Plumb- 
ers," "Open Spaces," "The Boarding out of Children," "Breakfasts to 
Poor Children," " Hygenic Dress," and " Poison Analysis," etc. Indeed, it 
would be quite impossible to mention a tithe of the good works organized 
and carried on by the National Health Society, in a quiet, unpretending 
way, without any fuss or blowing of trumpets. The new year, which has 



NATIONAL HEALTH SOCIETY OF LONDON 73 

just dawned, will probably see the Society's efforts still further extended. 
Miss Lankester, the secretary, has been appointed secretary to the English 
Women's Department, at the great World's Fair in Chicago, which em- 
braces every kind of women's industries. The National Health Society 
is represented here in its many phases of useful work. 

The Society deserves to be even better known than it is at present. 
Any who are interested in it can obtain the fullest information on applica- 
tion to me, as chairman of council, or to the secretary, 53 Bemers street, 
London, W. 

Any information as to organization will be readily afforded to American 
or other foreign correspondents, desirous of creating or developing similar 
organizations elsewhere ; and copies will be furnished of the list of publi- 
cations, leaflets, programmes, placards, and hand-bills. 



XVIL 

INFLUENCE OF INEBRIETY ON PUBLIC HEALTH. 

By T. D. CROTHERS, M. D., 

Superintendent Walnut Lodge Hospital^ etc., 

Hartford^ Conn, 

All growth, development, and civilization begins and ends in the in- 
dividual. Train and develop the citizen, and both the community and 
nation are raised. Sanitary science is founded on this principle. Any 
evils which increase the number of diseased and defective persons bring 
additional obstacles to life and peril to all law and order. Defective and 
diseased persons always impede the army of advance. The laws of 
evolution teach the survival of the fittest ; also the stem process of elimina- 
tion, with its crushing out and crowding out The unfit and defective 
must go to the rear ; they have no right or place on the active field of 
conflict. 

Inebriety is clearly more prominent as a: cause of disease and degenera- 
tion than any other factors known at present. The various authorities 
who have tried to tabulate the number of defectives due directly and in- 
dhrectly to inebriety have varied widely in their estimates, showing that 
the facts are not yet all grouped and studied. These estimates have 
placed inebriety as the active cause of from ten to sixty per cent, of all 
insanity ; from thirty to eighty per cent, of all pauperism ; from sixty to 
ninety per cent, of all criminality ; and from thirty to seventy per cent of 
all idiocy. These are the highest and lowest estimates made by various 
authorities in this countiy and Europe, and bring unmistakable evidence 
of the influence of inebriety, not only over public health, but over all 
growth and civilization. 

The mortality from this source is equally startling, no matter what the 
exact figures may be. Inquiry and observation in every community will 
bring ample confirmation of the magnitude of inebriety in disease and de- 
generation. Some of the relations of inebriety to public health will illus- 
trate the extent of its influence. 

It is a remarkable fact that public sentiment concerning inebriety and the 
drink problem is far beyond all medical and scientific interest in this sub- 
ject 

A political party with the central object of obtaining power to control 
and thus break up this evil, received two hundred and seventy-nine thou- 
sand votes last year. A large number of organized societies, composed 



INFLUENCE OF INEBRIETY ON PUBLIC HEALTH, 75 

of thousands of earnest men and women, are working for the same pur- 
pose. A host of revival orators are penetrating into every town of the 
country, holding meetings, and rousing up public sentiment to antagonize 
the drink evils. The churches are in this field with organized societies, 
urging moral means and remedies for this disorder. Over eighty journals 
and magazines are issued regularly from the press, devoted to this one 
cause. Hundreds of volumes and pamphlets are coming yearly from all 
parts of the country, and this literature is constantly growing more 
voluminous and aggressive. A feeling of alarm, with increasing efforts to 
find some means to check and neutralize this evil, is apparent ever3rwhere. 
On the medical and scientific side of this topic a half a dozen volumes 
have been written, a single journal devoted to this study is issued, and 
less than a hundred physicians have given any attention or become prom- 
inent as students or writers in this field. 

In all the great scientific questions of the times public sentiment follows 
timidly the lead of science. Here public opinion is leading, and is grow- 
ing more agitated and earnest to find relief, while medical science has so 
far failed to either direct or point out the lines of march. 

If we ascend above the agitation and conflict of theories, we are startled 
to find this great "drink army" to be the product of distinct causes 
and physical conditions, — to be bom, bred, grown, and developed in soils 
and environments that we can realize and control. 

The recruiting grounds, the sources and springs from which the inebriate 
comes, the direction of his march, destination, and end, and forces 
accelerating or retarding this movement, are clearly apparent to scientific 
inquiry. We are still more startled to find that this army of inebriates 
is increased and becomes more incurable by the blundering theories of 
public opinion, which seeks by law, pledge, and prayer to halt and drive 
them back to sobriety and health. 

Some idea may be formed of the influence of inebriety on the health of 
the public, from this fact : In 189 1, eight hundred thousand persons were 
arrested, charged with intoxication and crime following. At least half a 
million more are known to be using spirits and drugs to excess. This 
practically represents a vast army of non-producers, who are centers of the 
most unsanitary conditions of life and living. 

Also, an army that is " switched off the main line " of evolutionary 
growth and development, who are becoming more unfit, more degenerate, 
forming centers of pauperism, criminality, insanity, and progressive degen- 
eration, not only being eliminated and crowded out, but concentrating a 
tide of evil that is transmitted to the next generation. A point of view a 
little higher up reveals this drink army as a great retrograde movement of 
individuals whose brain structiure is breaking down, beginning at the high- 
est levels and following a uniform line of march beyond the uncertainties 
of human will and the feebleness of personal effort. 

The possibility of scientific interference, of limitation and prevention, 
increases with every advance of our knowledge of the causes. Already 



76 INFLUENCE OF INEBRIETY ON PUBLIC HEALTH. 

there is unmistakable evidence that inebriety can be checked and its evils 
removed, but only by the means of physical laws whose operations are 
above caprice. The same problem confronts us, as in other great reme- 
dial epidemics. Remove the causes and conditions which favor the 
growth and development of the disease, and place the victim in the best 
condition for returning health. Over a million recognized and unrecog- 
nized inebriates are scattered over all parts of the country, each one of 
whom is a center of degeneration, disease, and unhealthy sanitary life and 
living. Each one will transmit to the next generation a legacy of disease, 
lessened vigor, and imperfect development, crippling the generation to 
follow, with defects and limitations that cannot be described. 

The delusion of free will to do otherwise is the fatal error which per- 
mits this army of inebriates to continue, year after year, not only destroy- 
ing themselves and families, but to build up veritable centers of physical 
and mental ruin. Our indifference and criminal neglect of these classes 
result in literal breeding-places for a perpetuation and increase of all the 
evils and losses which follow from inebriety. 

Sanitary science teaches clearly that no one has a right to destroy him- 
self and peril the health and comfort of others. The inebriate is always 
a source of danger, and to permit him to become a criminal and pauper, 
before any legal remedy is applied, b a fatal error. The inebriate is a 
criminal pauper and madman, whose conduct forfeits all right to personal 
liberty, and who is practically an outlaw to his own and all other interests. 
The only remedy is legal control and quarantining in hospitals ; not as 
criminals, but as diseased and helpless, the same as in cases of yeUow- 
fever, small-pox, typhus, and other contagious diseases. The inebriate is 
a border-land maniac, and needs control, isolation, and treatment in 
special surroundings and in special conditions. Saloons and places for 
the free sale of spirits are breeding-centers of inebriety in every commu- 
nity. The sanitary perils which follow these places, and the physical and 
mental health of all its patrons, are not only destroyed, but the worst san- 
itary conditions are encouraged and grow up about these places. The 
saloon has no claim for recognition as a business. It is simply a parasite 
thriving on the decay and degeneration of the community. It is only 
tolerated by the densest ignorance and selfishness of its defenders. Sa- 
loons should be literally classed with foul sewers, dangerous waters, and 
the worst unsanitary death-dealing agents. Persecution as a moral evil 
only keeps it alive, but any study from a scientific point of view would be 
fatal to its perpetuity. 

Unregulated marriages are another unrecognized great breeding-center 
for the growth of inebriety. To-day inebriates, insane, and neurotics of 
all stages, also criminals, are permitted to propagate and transmit their 
defects to the next generation. The result is a race of defectives who 
develop, under any or all circumstances, inebriety and all its associated 
degenerations. Thus, the inebriate pauper, criminal, and insane, are bom 
and bred with absolute certainty. All authorities agree that from sixty to 



INFLUENCE OF INEBRIETY ON PUBLIC HEALTH. 77 

eighty per cent, of all inebriates who come for treatment in asylums are 
so by inheritance. Every community furnishes illustrations of this fact. 
This alcoholic stream, with all its criminal paupers and insane, is permitted 
to flow down through every community, and the inmates of every hospital 
and the victims of every police court are living witnesses of this stupid 
blunder. 

Another recruiting-place for inebriety is the station-house and jail, and 
the legal treatment by fines and imprisonment. Of the eight hundred 
thousand persons who were arrested for inebriety, less than one tenth of 
one per cent, received any benefit. They were all made worse, and trans, 
formed into armies of inebriates who never desert nor leave the ranks. 

Physically, the short imprisonment of the inebriate simply removes him 
from spirits and leaves him less capable of leading a temperate life. 

Mentally, he has lost a certain self-respect and pride of character essen- 
tial to recovery. 

The first legal punishment of inebriates is followed by a species of 
fatality, seen in a constant repetition of the same or allied offenses. 

This fact is so apparent that these cases are called '' repeaters " in the 
courts, and the number of sentences to the same person often extends to 
hundreds. 

In one thousand cases confined at Blackwell's Island, New York, 935 
had been sentenced for the same offence, drunkenness, from one to 28 times. 

The first sentence was a regular switch-point, from which the victim was 
precipitated to a constantly descending grade, becoming more and more 
incapacitated for temperate living. 

The system of fines is equally ruinous, because it falls most heavily on 
the families, making it more difficult to support themselves, thereby increas- 
ing the perils of pauperism, both to the victim and those who depend on 
him for support. 

It may be said, and the statement is sustained by many facts, that the 
legal treatment by the lower courts of cases of inebriety is fully as fatal 
as the saloons themselves where spirits are sold. 

The saloon and police court are literally the school and college for the 
training and graduation of classes of incurable inebriates that peril every 
sanitary interest in the country. 

The fault is not in the courts and their administration of the law, but 
in the laws themselves, and in that state of public opinion which urges 
that all inebriates should be treated as wilful criminals, and arrested and 
punished as such. 

Thus, year after year, this terrible farce of prevention of inebriety by 
fines and short imprisonments goes on, and the incurability of the poor 
victims increases. Crime is increased, pauperism is increased, the most 
dangerous sanitary conditions are fostered, and the burdens of taxpayers 
and producers are increased. 

The inebriate is always debilitated, and suffers from impaired brain and 
nerve force. Alcohol has broken up all healthy action of the body. 



78 INFLUENCE OF INEBRIETY ON PUBLIC HEALTH, 

In prison both the quality and quantity of food are ill adapted to restore 
or build up the weakened organism. 

The hygienic influences of jails and prisons are defective in every re- 
spect, and adverse to any healthy growth of body or mind. 

The psychological influences also are of the worst possible character. 
The surrounding and the associates precipitate the victim into conditions 
of mental despair, from which recovery is difficult, if not impossible. 

The only compensation to the inebriate is the removal of alcohol, and 
in this deprivation the state most terribly unfits him and makes him more 
and more helpless for the future. 

Thus, while false theories are one of the sources from which inebriety 
is produced, the blundering effort to remove it by penal punishment is an 
actual factor in increasing and intensifpng the disorder. 

The treatment of inebriety from a scientific stand-point has passed the 
stage of experiment, and is supported by a great variety of experience and 
collateral evidence that cannot be disputed. 

Probably the largest class of inebriates in this country are without 
means of support, and may be termed the indigent and pauper class. 

This class, non-supporting and burdensome, should come under legal 
recognition, and be committed to workhouse hospitals, built for this pur- 
pose, preferably in the country, upon large farms and amid the most favor- 
able envioronment.' 

These hospitals should be training schools, in which medical care, 
occupation, physical and mental training, could be applied for years, or 
until the inmates had so far recovered as to be able to become good 
citizens. 

These places would receive the classes who now are sent to jail, and 
that other class who are neglected until they have passed into the chronic 
stage and have become inmates of prisons and insane asylums. 

A very large proportion of these several classes couJd be made self- 
supporting while under treatment, and in many cases be an actual source 
of revenue. The hospitals would naturally be divided into two classes. 
The first would receive the better, or less chronic, cases ; the second would 
have the incurables, and those whose recovery was deemed more or less 
doubtful. In one case the surroundings and discipline would be more 
adapted for the special inmates than in the other, but the same general 
restraint would be followed in each. 

In both, recoveries would follow. A large class would be restored to 
society and become producers. In the second, such cases would be housed 
and made to take care of themselves, which would be an immense gain to 
society in economy and safety. 

Private enterprise should be encouraged by legislation to provide small- 
er hospitals for the better class, and for those who would be unwilling, or 
whom it would be undesirable to compel, to enter public asylums. Here 
the commitments should be both forced and voluntary, and the restraint 
combined with the fullest and latest appliances of science for the end to 



INFLUENCE OP INEBRIETY ON PUBLIC HEALTH. 79 

be accomplished, blending seclusion and good surroundings to build up 
and make recovery possible. 

The first step is to recognize the fact that the inebriate, whether con- 
tinuous or periodic, has, to a greater or less degree, forfeited his personal 
liberty, become a public nuisance, and an obstacle to social progress and 
civilization. Second, that he is suffering from a disease which affects 
society and every member of the community in which he lives, and from 
which he cannot recover without aid from other sources, making it abso- 
lutely necessary that he should be forced into quarantine, on the same 
principle as the small-pox or yellow-fever patient This is simply carry- 
ing out the primitive law of self-preservation. Naturally, the money to 
accomplish this shall come from the license revenue, on the principle that 
every business should provide for the accidents and injuries which follow 
from it. Railroad companies and other corporations are required to pay 
damages for the accidents which follow their business, and this is con- 
ceded to be justice. But to-day the tax on the liquor traffic is used to 
support courts and jails, where the inebriate, by fines and imprisonment, 
is only made worse or more incurable. Thus, literally, the business of 
selling spirits is increased by the almost barbaric efforts of courts and 
jails, and every person so punished is made a permanent patron of that 
business. Against this all the teachings of science and all practical study 
utter loud protest. 

The practical success of work-house hospitals for inebriates is demon- 
strated in every self-supporting jail and state prison in the country, where 
the obstacles are greater and the possibilities of accomplishing this end 
more remote. This can also be seen in asylums for both insane and in- 
ebriates, in the various sanitaria and hospitals through the country, where 
the capacity for self-support and the curability of these cases are estab- 
lished facts. 

More than that, these hospitals would relieve society of great burdens 
of loss and suffering, and the diminution of the number of the inebriates in- 
deed become a practical certainty, the extent of which we can have no 
conception of at present. 

It is impossible, at the present time, to estimate the beneficial results 
that would follow -a systematized plan of thus housing and treating the 
inebriate, but there are positive indications that its effect would be felt in 
all circles. One of the great fountain-heads of insanity, criminality, and 
pauperism would be closed, and a new era would dawn in the evolution 
of science. 

The neglect to study inebriety scientifically, and its influence on public 
health, has opened the door for an army of quacks, who rush in with secret 
remedies to drive out this disorder. It is the same old story of credulity, 
disappointment, and loss ; a repetition of the blind leading the blind and 
both falling into the ditch. The failure to study inebriety as a problem 
in sanitary and medical science is a neglect for which the severest penal- 
ties must be paid. These armies of inebriates, who are uncontrolled and 



8o INFLUENCE OF INEBRIETY ON PUBLIC HEALTH, 

practically unknown, infest our communities, and are the certain promise 
of misery, sorrow, and loss in the future. The failure to study the condi- 
tions and causes which produce inebriety, and remove them, is to increase 
inebriety, criminality, and pauperism, and all their attendant evils, in the 
years to come. New asylums and homes will be required to-morrow ; new 
burdens of disease, loss, sorrow, and death will follow in the next genera- 
tion. Thus, the evils we recognize in part, and the burdens we are called 
to bear, are growing and being cultivated in our midst, and will bear fruit 
as surely as the oak comes from the acorn. 

The public health of to-day and tomorrow depends very largely on the 
prevalence of inebriety. If we can control and stamp this out, one of the 
great fountain-heads of criminality, pauperism, and insanity will be closed. 
If all the efforts of church, state, moralists, and quacks could be concen- 
trated along the side of exact science, by a study of the facts, conditions, 
and laws which control the origin and growth of inebriety, the means and 
remedies for its prevention and cure would be no mystery. To the stu- 
dent of this subject, the possibilities of preventing and stamping out in- 
ebriety are only limited by our want of exact knowledge. Looking over 
into this unknown realm of sanitary science, we see clearly the same reign 
of physical laws, the same cause and effect, the same circumstances and 
conditions which develop insanity, pauperism, idiocy, and literally switch 
the victim from the main track of growth, development, and evolution, to 
the side lines of degeneration, disease, and dissolution. 

The same germ-forcers are at work here, following lines as fixed and 
eternal as those which govern the stars. 

The influence of inebriety on public health is profound and far-reaching, 
and within the observation of every one. Its remedy must come from the 
teachings of accurately-observed facts, and along the line of great natural 
laws. 



XVIII. 
HYGIENE OF HAIR-DRESSERS' AND BARBERS* SHOPS. 

By Dr, angel CONTRERAS. 

Delbgatb from the State of Yucatan, 

Mexico, 

Every man living in a civilized country has occasion to frequent more or 
less those establishments which are called hair-dressers' or barbers' shops, 
either for the purpose of having his hair cut, or of having his beard 
shaved, as it is only in those communities under the most primitive or 
savage conditions where men allow the hair to grow in a natural state. 

In these establishments we find that the same utensils and the same 
hands are applied to the skin or capillary bulbs of different individuals, 
without any intermediate cleansing or disinfection. Some of these per- 
sons are very probably already diseased, and thus give occasion for the 
transmission of their disease ; especially, if during the use of the razors or 
the scissors there has been any abrasion or cutting of the skin. 

Under these circumstances, it appears to me that it comes within the 
scope of this philanthropic Association, whose noble object is to apply the 
scientific progress of the age to the prevention of disease, to meditate on 
and point out the measures which may be conducive to this laudable 
object ; and should the suggestions herein proposed to this Association, 
on the subject, by one of its humblest members, not meet with approval, 
I hope others more effective may be brought up for discussion, and that 
the shortcomings may be overlooked in consideration of the good inten- 
tions of the writer. 

The disease which persons are undoubtedly most liable to contract in 
barbers' shops is that of scurf, and I shall therefore touch on what appear 
to me the most important points in a consideration of this matter. 

Scurf is understood to be a disease of the capillary system, caused by 
the presence of vegetable parasites. 

These diseases are characterized by the falling out of the hairs from 
the head and beard, accompanied by the different symptoms which take 
the forms of scurf, dandruff, and baldness. 

The micro-organisms which are developed are the Achoriom Schoen- 
leinill, the Tricothyton tonsurans, and the Microsporon furfur. Like all 
others of their species, these micro-organisms are destroyed under the 
action of caloric at 120 degrees C. 

The only determining cause of scurf is the contagion, by the direct or in- 



82 HYGIENE OP HAIR-DRESSERS' AND BARBERS' SHOPS. 

direct transmission of the vegetable parasite; but as Hardy says, in 
order that this parasite may develop and produce the disease, it must find 
itself in favorable circumstances, such as are especially presented by 
young and lymphatic persons, or those who, from whatever cause, are 
debilitated. The existence of such a necessary condition for the devel- 
opment of the disease, explains the immunity which certain persons enjoy 
who are exposed to contagion, and, at the same time, the facility with 
which other persons contract the disease. 

The disease can be transmitted by some animals which already have it ; 
but the contagion most commonly takes place from person to person, and 
as Eichorst says : '' In families, in educational establishments, and in bar. 
racks, the disease sometimes assumes an endemic character, and several 
times the center of this propagation has been found in a hair-dressers' or 
barbers' shop, and has arisen from the use of instruments which have been 
badly cleansed." 

Besides the disease of the capillary system, there are many others which 
are developed in the skin of the head, or of the face, with different elemen- 
tary lesions, such as maculas, vesicles, pustules, scabs, etc., and which 
arise from the tuberculous scrofula, syphilis, herpetism, or some local 
cause. Their contagious character is generally admitted; although, in 
the greater part of them, their microbiotic nature has not been scientific- 
ally demonstrated. These diseases are : scrofulides, syphilides, leprosy, 
herpes, eczema, lichen, pitiriases, etc., and they can all be considered as 
belonging to the same class as scurf. 

Barbers and hair-dressers ought, therefore, to be very careful in clean, 
ing the utensils which have served for one person before they are 
employed on another ; and this care ought especially to be used in cases 
where the customer has a contagious disease. 

In such cases, it would be necessary to subject the combs, brushes, 
shaving brushes, towels, etc., to the action of caloric for the space of ten 
minutes, in a steam vessel or receptacle with a heat of 120 degrees, C. 
(Chamberland's Autoclove), and the razors in the oil bath. 

The hands of the person who has touched the diseased customer 
ought also to be disinfected, in the same way as surgeons disinfect theirs. 

They should be perfectly well washed in warm water with carbolic acid 
soap ; the nails ought to be well cleaned out with a nail brush, and the 
hands ought afterwards to be immersed for a few minutes in a solution of 
bichloride of mercury of one to one thousand. 

The washing of the utensils and of the hands with warm water, either 
pure or containing alcohol, or a trifle of carbolic acid, is a very insecure 
and insufficient means to guarantee the destruction of the parasite which 
carries the contagion; and in those cases in which the parasite does not 
exist, it is a mere matter of washing hands, as required by the customs of 
civilized society; but, as it is not easy for the ordinary employ^ in a 
barber's shop to discover the existence of a contagious disease, prudence 
demands that the precautions of cleansing and disinfection should be 



HYGIENE OF HAIR-DRESSERS* AND BARBERS* SHOPS. 83 

taken in every case ; and that the loose hairs cut from the heads of cus- 
tomers should be burned. 

The price of a disinfecting stove would in many cases be much less than 
the majority of the ornaments which are generally seen in this kind of 
establishments, and its heat could be often utilized in obtaining hot water^ 
in heating curling tongs, in drying and ironing towels, etc. 

The manufacturers can easily design the most convenient and economi- 
cal models for such stoves, a subject that I do not enter on, as they can 
be made in many different forms. 

Before concluding, I earnestly request the attention of all the members 
of this great and progressive Association, in order that, if they approve of 
the opinions I have expressed, they may, within their respective spheres 
of action, use their best efforts to procure the use of these stoves by the 
barbers and hair-dressers, and see that such stoves be heated to 120 
degrees C, so as to guarantee the destruction of the micro-organisms, 
which may have infected utensils, that none of these be used without 
previous sterilization ; and that the employes carefully cleanse and disin- 
fect their hands immediately after shaving or cutting the hair of a 
customer. 



XIX. 

ANIMAL VACCINE^WHY IT SHOULD BE PREFERRED TO 
HUMAN VACCINE. 

By MIGUEL MARQUEZ, M. D., 
Vice President of the Board of Health in the State of Chihuahua, 

Mexico, 

Ever since it has been demonstrated that syphilis can be transmitted 
from one person to another through human vaccine — and it is admitted as 
a scientific fact ; ever since such a competent authority as Dr. Ricord, the 
French specialist on syphilis, said : '^ The child from whom the vaccine is 
taken may be afflicted with syphilis to a state of incubation, or without 
any outward demonstrations." 

Ever since the Academy of Sciences of France awarded the premium 
of ten thousand francs to Bousquet, Friard, and Stimbrenner, authors of 
three very important memorials, in which it was resolved, with a great 
number of testimonials and with the most brilliant success, that the human 
vaccine has degenerated, and its preserving qualities against the small-pox 
have diminished; and that since the vaccination from arm to arm the 
lymph derived from vaccinated persons has been decreasing and con- 
stantly losing ground in practice, while animal vaccine progresses rapidly, 
at such a rate that at the present time, in Europe and the United States, 
nobody will allow himself or herself to be inoculated with vaccine that is 
liable to carry the germ of such a terrible disease as syphilis. 

In the epochs of epidemics, and whenever a large quantity of vaccine 
lymph is required at a given moment, the production and collection of 
human lymph have been insufficient to meet the circumstances and supply 
the demand, and it is exceedingly difficult, even in ordinary cases, to 
assemble the vaccinated persons that they may be utilizable ; and, more- 
over, that all parents consent to have the lymph taken from their children. 

If at the first prophylactic glance animal vaccine is preferable, its 
adoption is legally indispensable; and from the instant vaccination is 
compulsory in the state, it is prudent to permit the citizens, who have an 
equal right, to repel that vaccine which, however remotely, is capable of 
originating a disease that, like syphilis, can be promoted by the inoculation 
of human vaccine. 

It is economical, too, in the institution of animal vaccine, to have vaccina- 
tion establishments, one at least in each state, that could provide lymph in 
abundance for the entire population ; and if we compare what this would 
cost to what the government itself has advised in one of its several circu- 
lars, in which it counsels the governors of the states to organize the service 



ANIMAL VACCINE, 8$ 

of vaccination in such a manner that in every town or village where a 
doctor resides, to charge him with administration of vaccine and compel 
him to visit all places within his reach, where there is no doctor at least 
twice a year ; it results that at least twenty-five dollars monthly would 
have to be paid to each doctor, and very few would accept such a vast 
amount of work for such a small fee ; while for half this sum that each 
district would give as an aid to the vaccine institutes, they would secure 
an abundant return of vaccine points to supply their demands plentifully. 

If to the above we add that only in large cities vaccine is recommended, 
and in charge of doctors legally authorized, and some of them are careless 
and inattentive and place in the hands of a layman so important a branch 
that requires a scrupulous observation, and it is not rare to see, even in 
Mexico and the capitals of the states, half an hour or one hour at most 
devoted to vaccination, hardly time enough for the vaccinating itself, and 
not enough to make other very necessary observations : the result of which is 
that we are in want of authentic data and reliable statistics, the oply 
source and true criterion from which to learn in a positive manner what 
the result of human vaccine in the country has been. 

We do not disavow that in spite of the inconveniences that the 
organization of the service of vaccination suffers in the republic, they 
have contributed powerfully, associated with other health-promoting 
measures, to diminish the ravages that the small-pox epidemics have made 
in the country, and it is well known that in the last few years the enforce- 
ment of sanitary laws, as well as the improvements of social conditions, 
is another factor that influences public health. 

As it is stated that " Up to the present, human vaccine practised from 
arm to arm has been enough to prevent the small-pox, avoiding as much 
as possible the inoculation of maladies such as syphilis, and those who 
have practised this simple operation for many years have not known the 
vaccine to have degenerated, and the experience of nearly eighty years in 
the republic has proved its efficacy." 

Now we will show that the above is far from being true and that the 
small-pox exists in the republic, and has existed, and there is a territory 
comprised between the i6th and 24th degrees of latitude, and the 6th 
degree West and the 4th degree East from the meridian of Mexico, where 
it is most frequent. 

From this territory must be excepted the states of Colima, Queretaro, 
and Morelos; the district of Juchipila in Zacatecas, the district of 
Aguascalientes in Aguascalientes, the district of Leon in Guanajuato, the 
seventh district of Nuevo Leon, the southern district and the fourth 
district of Tamaulipas, the counties Guzman and Mascota in Jalisco, the 
province of Santiago Ixcuintla in the territory of Tepic, the districts 
Tacimbaro, Apatzingan, Coalcoman, and Jiquilpan in Michoacan; the 
districts of Imiquilpan, Metztitlan, and Zimaipan in Hidalgo; all the 
districts of San Luis Potosi excepting those of Tancanhuitz Mineral de 
Catorce and Guadalcazar ; the district of Puebla, Alatriste, Atlixco, San 



86 ANIMAL VACCINE. 

Juan de los Llanos, Matamoros, Zacapoaxtla, Zacatlan, and Chiautla, in 
Puebla; the counties of Huatusco, Misantla, Chicontepec, Jalapa, 
Ozuluama, Tuxtla, Papantla, and Tantoyuca, in Veracruz ; the districts of 
Abasolo, Alarcon, Bravos, Galeana, Guerrero, Hidalgo, Union, Mina, and 
Tabasco in Guerrero ; those of Choapan, Yamiltepec, Juquila, Pochutla, 
Toetitlan, Tehuantepec, Zuatepec, Tlaxiaco, and Yautepec, in Oaxaca. 

The states where small-pox is most frequent are those situated on the 
central table-land, such as San Luis Potosi, Zacatecas, Aguascalientes, 
Guanajuato, Hidalgo, Mexico, Puebla, Tlaxcala, and Distrito Federal. 

The epidemics, from the time of the independence up to date, according 
to statistics, are as follows : 

In 1828 and in 1829 in the state of Oaxaca. 

In 1833 in the state of Colima. 

In 1841 in the state of Guerrero. 

In 1845 and in 1849 ^^ ^^ ^XzXa of Oaxaca. 

In 1850 in the states of Chiapas, Mexico, and Veracruz. 

In 185 1 in the state of Colima. 

In 1852 in the state of Mexico. 

In 1853 and 1854 in the states of Chiapas, Oaxaca, and Yucatan. 

In 1855 in the states of Guerrero, Hidalgo, Yucatan, and 2^catecas. 

In 1857 in the states of Hidalgo and Oaxaca. 

In 1858 in the states of Chiapas, Guerrero, Mexico, and San Luis 
Potosi. 

In i860 in the states of Chiapas, Colima, Hidalgo, and Mexico. 

In 1862 in the state of Mexico. 

In 1863 in the state of Guanajuato. 

In 1864 in the states of Guerrero, Mexico, and Oaxaca. 

In 1865 in the states of Guerrero, Hidalgo, Mexico, and Oaxaca. 

In 1866 in the states of Mexico and Oaxaca. 

In 1867 in the state of Oaxaca. 

In 1868 in the states of Mexico and Oaxaca. 

In 1869 in the state of Oaxaca. 

In 1870 in the states of Guerrero and Hidalgo. 

In 187 1 in the states of Hidalgo, Mexico, and Sinaloa. 

In 1872 in the states of Chiapas, Mexico, Hidalgo, Oaxaca, Veracruz, 
and Zacatecas. 

In 1873 in the states of Hidalgo, Oaxaca, Puebla, and Veracruz. 

In 1874 in the states of Colima, Guerrero, Hidalgo, Oaxaca, Sinaloa, and 
what is at present territory of Tepic. 

In 1875 ^" ^^ states of Durango, Guerrero, Oaxaca, and Yucatan. 

In 1876 in the states of Hidalgo and Oaxaca. 

In 1877 in the states of Jalisco, Mexico, and Oaxaca. 

In 1878 in the states of Mexico, Oaxaca, Puebla, Tamaulipas, Veracruz, 
and Zacatecas. 

In 1879 in the states of Colima, Guanajuato, Mexico, Oaxaca, Puebla, 
and Veracruz. 



ANIMAL VACCINE, 87 

In 1880 in the states of Chiapas, Durango, Guerrero, Hidalgo, Mexico, 
Oaxaca, Puebla, and Veracruz. 

In 1 88 1 in the states of Guerrero, Mexico, Oaxaca, San Luis Potosi, 
Sonora, Veracruz, and Zacatecas. 

In 1882 in the states of Chiapas, Durango, Guerrero, Hidalgo, Mexico, 
Oaxaca, and San Luis Potosi. 

In 1883 in the states of Chiapas, Hidalgo, and Oaxaca. 

In 1884 in the states of Chiapas, Durango, Oaxaca, Veracruz, and 
Yucatan. 

In 1886 in the state of Sinaloa. 

In 1887 in the state of Puebla. 

In 1889 ^^ ^^ Distrito Federal, and especially in the capital. 

An occurrence expressive enough against human vaccine has just taken 
place at the capital of the republic, where the physicians cannot be 
accused of unskilfulness, but that the vaccine has lost its preserving 
properties. The '' Siglo XIX " (nineteenth century) called the attention 
of the board of health to the alarming frequency with which cases of 
small-pox were occurring, to which the secretary of the board replied that 
the vaccine had been administered as in no other epoch, that the nimiber 
of vaccinated persons was greater there than in any other city in the 
world ; in a word, that the service of vaccination was perfectly attended 
to ; and notwithstanding, how can it be explained that the small-pox is at 
its full height ? It is incontrovertible, in my opinion, that if, notwith- 
standing the prodigality of vaccine administered by experienced persons, 
the small-pox continues the same, this depends upon the lymph inoculated 
not being able to preserve against it, and of course it can be satisfactorily 
proved, if all the cases of small-pox were investigated, if the patients have 
been vaccinated and under what circumstances and what was the 
immediate result of the vaccine. 

It has remained proved by the preceding article that the human vaccine 
has been powerless to avoid small-pox; that it exists in the territory 
enumerated above, and it has presented itself in the form of the great 
epidemics above mentioned. 

From a very commendable work written by the celebrated Dr. D. 
Orvananos, we quote the following : ^ In the republic, human vaccine is 
used exclusively for vaccination, and it is time that animal vaccine should 
be preferred, as in many other countries." 

In the National Congress of Hygiene, assembled at the capital in 1884, 
it was decided '* to establish in the National School of Agriculture, and in 
charge of the professor of clinics of that school, a conservatory devoted 
to the study, preservation, and culture of animal vaccine." 

This provision is absolutely necessary, because, as the board of health 
of Michigan says : 

The reasons for preferring bovine virus to human virus can be abridged 
as follows : 

I St. With the bovine virus a more perfect unfolding of the vaccinal 



88 ANIMAL VACCINE. 

pustules is obtained, and it is to be inferred from this that it confers a 
greater protection against the small-pox. 

2d. With bovine virus there is no danger of imparting syphilis, if a 
perfectly clean lancet is used. 

3d. Bovine virus distributes better than human virus for revaccination, 
and it is probable for the same reason that the former succeeds and the 
latter fails : it is because the former removes any remaining predisposition 
that the human vaccine cannot always destroy. 

4th. When large quantities of vaccine virus are required, as happens in 
times of epidemics, it can be procured more easily through the medium of 
animal vaccine. 

In conclusion, we will say that the vaccine institutes established years 
ago in Paris by Lanoix and Chambou, in Belgium by Warlomont, and in 
Germany by Pissin, have progressed remarkably ; that the establishments 
of this kind have multiplied wonderfully; that Holland, Switzerland, 
Russia, Spain, etc., etc., are following in the same manner. In the 
United States animal lymph is used exclusively, this branch being 
represented at the Chicago exposition by Dr. H. M. Alexander, who 
exhibits it in a particular section of his great institute denominated ^'The 
Lancaster County Vaccine Farm." 

Mexico, too, has its vaccinal institutions, in the school of agriculture 
under the charge of the celebrated Prof. J. de la Luz €k>mez. It was 
established some time ago by the learned director of the Military Hospital 
of Instruction, and some states, such as San Luis Potosi, are today 
centres where the animal lymph is cultivated and preserved, the only 
lymph that will be used in the future in the towns that lie in the vanguard 
of civilization and progress. 

We have seen by the above, that to continue the use of human vaccine 
is attended by grave inconveniences, that are advantageously avoided by 
the use of animal vaccine, and that the latter is adopted for being distrib- 
uted, that its beneficent influence may be felt, even in the smallest villages, 
hamlets, and ranches, by distributing great quantities of vaccine points ; 
that an intelligent person can innoculate without the least danger ; that we 
will not expose to the judgment of any individual to determine whether a 
child is or is not well, or if the lymph should be taken from it and trans- 
mit inconsequently syphilitic virus ; and of course the adoption of animal 
vaccine will suppress forever the custom of vaccinating from arm to arm. 

Summary : The animal vaccine should be preferred to human vaccine 
because : 

I St. It does not transmit syphilis and preserves more efficiently against 
the small-pox. 

2d. It can produce at a given moment large quantities of lymph, fresh, 
pure, and genuine, at a very small cost. 

3d. Its administration can be trusted to any intelligent person without 
the least danger. 



XX. 

YELLOW COLORATION OF PERSONS ATTACKED BY 
"VOMITO PRIETO." 

By Dr. MANUEL CARMONA Y VALLE, 

dlkector of the national school of medicine of mexico, professor of 

Internal Clinics, Member of the Academy of Medicine of Mexico, 

AND Several Scientific Societies, 

Mexico. 

The yellow coloration which is so peculiar to the persons attacked by 
the " Vomito Prieto," is so specially characteristic of this disease, that it 
has been more than enough to give it the name under which it is known 
in all languages, "Fiebre Amarilla," "Yellow-Fever," "Fievre Jaune." 
For this reason, all the observers who have made a study of the disease 
have occupied themselves especially with this symptom, and with attempts 
to explain the mechanism of its production. The idea which has mostly 
prevailed amongst these observers, is that of explaining this coloration by 
the presence of the coloring matter of the bile in the blood itself, and 
almost all writers now speak of it as bilious jaundice. 

I have dissented from this doctrine ever since the year 1881, and I 
found my difference of opinion on the fact, that in experimenting on the 
urine of patients who had reached the plentitude of yellor coloration, the 
chemical reagents did not reveal the reaction which is characteristic of the 
coloring matters in the bile. I afterwards continued my analysis with all 
the urines that I could procure from yellow-fever patients, and the result 
has always been the same. It has several times happened that I have 
met with urines which, from their greenish-yellow shade, might have cer- 
tainly been classed as truly jaundiced, but even in these cases I did not 
find absolutely any of the reactions which are peculiar to the coloring 
matters of bile. Feeling some doubt of my own work, I sent some of 
these samples to distinguished chemists, and in every case I found my 
own conclusions corroborated. 

On the other hand, I found in these urines a substance which gives 
them a straw-yellow color, and which has no similarity to any of the color- 
ing matters of urine which have been described up to the present date. 
I have named this substance, " Ictheroidine," and I consider that this is 
the substance which determines the color which is invariably to be found 
in our patients. 

Both in my lectures on the etiology and prophylaxis of yellow-fever. 



90 COLORATION OF YELLOW-FEVER PATIENTS, 

as well as in the paper which I read before this Association in Mexico at 
its meeting of last year, I have described the processes which I followed 
in its preparation. These consist in the precipitation of the urine by 
acetate of lead ; filtration ; after that, the elimination of the excess of 
lead by means of a current of carbonic acid, followed by a new filtration 
and by the natural evaporation of the liquid thus obtained. 

This process is certainly defective, because the precipitates are of such 
an intense yellow color that doubtless a great part of the ictheroidine is 
lost therein. 

I now wish to describe some facts that I have discovered in making 
this preparation, and also to present to you, by way of example, a small 
quantity of the ictheroidine that I refer to. 

I must first point out the fact, that all urine proceeding from a yellow- 
fever patient has a remarkably acid reaction, and besides, that this 
acidity never disappears, even during putrefaction. Urines that have 
been kept for a year, and even longer, always preserve a perfectly acid 
reaction. 

Now the ictheroidine obtained by the process above described pre- 
serves the remarkable acidity of the urine, and when I first observed this 
phenomenon, I believed that I would find it necessary to change its name 
of ictheroidine, which carries the idea of an alkaline product, for that of 
"ictheroidic acid." But I afterwards discovered, that if, instead of aban- 
doning the liquid to spontaneous evaporation, it was submitted to a tem- 
perature of 50® or 60® C, it would then, on reaching a certain degree of 
concentration, form a greater number of crystals in the shape of long, 
white needles, leaving, as a residue, a liquid of the consistency of honey, 
which has all the characteristics of the ictheroidine, but having a reac- 
tion which is not acid but remarkably alkaline. 

On several occasions I forwarded some of these crystals to the dis- 
tinguished chemists, Messrs. Uribe and Morales, and those gentlemen 
were perfectly agreed that the crystals gave all the reactions of pure 
urea. 

I have related the facts exactly as they passed, and without any com- 
mentary whatever, believing that anybody who likes may prove them for 
himself, by repeating the experiments that I have related. It is difficult 
to understand how the urea, which is a neutral principle, united to the 
ictheroidine, which has an alkaline reaction, can produce such an exces- 
sively acid composition as the product which I obtained in my first 
experiments. 

Let this be how it will, I now present you a specimen of the ictheroi- 
dine, and you will observe that it is a heavy liquid, with a consistency of 
thick honey, of a reddish-yellow color, and entirely soluble in water, which 
it stains yellow. 

Absolute alcohol only dissolves a very small quantity, but still sufficient 
to take a straw-yellow color of a distinct shade. Chloroform will dis- 
solve even less, and it appears to be entirely insoluble in ether. Both in 



COLORATION OF YELLOW-FEVER PATIENTS, 9I 

absolute alcohol and ether, ictheroidine sinks to the bottom of the vessel^ 
whilst in chloroform it rises to the surface of the liquid. 

I ought to point out that the sample which I now present you has a 
high red color, which is due to its proceeding from a hemorrhagical urine. 
In ordinary cases it has a reddish-yellow color, as I have before stated. 

In one word, there is a great deal yet to be done before we can con- 
sider the study of this coloring principle complete ; but I believe that 
with what I have now brought forward, I will have furnished enough data 
to excite the attention of observers. 



XXL 

THE CANADIAN QUARANTINE SYSTEM. 

By FREDERICK MONTIZAMBERT, M. D. Ed.; F. R. C. S. E.; D. C. L., 
Grosse Isle, P, Q. 

THE QUARANTINE STATIONS. 

1. The quarantine stations of Canada at the Atlantic maritime ports 
are, — 

(a) Grosse Isle, in the River St. Lawrence, with Rimouski, the Louise 
Embankment, and the Grand Trunk wharf at Ldvis, as sub-stations, 
province of Quebec ; 

(d) Halifax, the harbor and Lawlor's Island, in the province of Nova 
Scotia ; 

(c) St. John, the harbor and Partridge Island, in the province of New 
Brunsvrick ; 

(d) Sydney, Cape Breton, in the province of Nova Scotia ; 

(f) Pictou, in the province of Nova Scotia ; 

(/) Hawkesbury, in the province of Nova Scotia ; 

(g) Chatham, in the province of New Brunswick; 

(A) Charlottetown, in the province of Prince Edward Island. 

2. On the Pacific coast : 

(a) Williams Head, including Albert Head, in the Strait of Fuca, 
province of British Columbia, and also including as a sub-station the port 
of Victoria ; and 

3. Every other port, on both oceans, at each of which the collector of 
customs is the quarantine officer, such port being designated an unorganized 
quarantine station ; 

4. And every inland customs port on the Canadian frontier, between 
the Pacific and Atlantic oceans, each such port being designated an un- 
organized inland quarantine station. 

The following is a brief sketch and history of the various quarantine 
stations of the Dominion : 

GROSSE ISLE, QUEBEC 

The quarantine station at Grosse Isle, the most important on the 
Atlantic coast of Canada, consists of an island in the St. Lawrence about 
thirty-one miles below Quebec. It was selected for quarantine purposes 
at the time of the first advent of cholera to this continent, in 1832. It 
lies in the stream about four miles and a half from the south shore of 
the river, about six miles from the north shore, and two miles or more 
from the " fairway " or channel along which incoming and outgoing vessels 



THE CANADIAN QUARANTINE SYSTEM, 93 

pass. No one is allowed to reside on the island except the employes and 
their families. A written permit from the officer in charge is required 
before any one can either land on the island, depart from it, or, when 
infectious disease is present, pass from one of its divisions to another. 

Its positions and capabilities of isolation are therefore exceptionally good. 

The island is a well wooded one, between two and three miles long, 
and covers some seven hundred acres. It is divided into sick, central, 
and healthy divisions. 

In the sick division, at the eastern extremity of the island, are the 
hospitals, and the quarters of the hospital staff. 

There is a two-story brick hospital with one hundred beds, including 
some in private wards, for cabin passengers, ships' officers, etc., and a 
detached one-story wooden shed with four separate wards, and about 
seventy beds, for cholera and small-pox patients. There are also ample 
facilities provided for the washing, disinfection, and fumigation of bedding, 
clothing, etc. 

In the central division are the residences of the inspecting officers and 
of the crew of the inspecting steamer. In this division also the churches 
(Protestant and Roman Catholic) and the chaplains' residences are placed. 

In the healthy division, at the western extremity of the island, are the 
houses of detention for suspected passengers from infected vessels. 
These detention houses, nine in number, are grouped in twos and threes, 
and furnish in all accommodation for about one hundred and twenty-four 
saloon passengers, two hundred second cabin, and fifteen hundred steerage 
passengers. In this division also is a wash-house, with six furnaces and 
boilers ; a bacteriological laboratory ; a bath and closet-house with twelve 
baths and sixteen water-closets for men, and six baths and eight closets 
for women ; a bakery, a forge, an oven for hot air disinfection ; a fumigating 
room, police barracks, etc. There is also a steam disinfecting house with 
three iron chambers, twenty-five feet by eight feet six inches, with boilers, 
etc., for the disinfection and sterilization of clothing and luggage, by 
steam. In the same building are twelve rain or needle baths for the 
washing with a disinfecting solution the persons of suspects while their 
clothing is being sterilized in the steam chambers. Two powerful pumps 
supply water from the end of the pier to reservoirs on a hill with a 
capacity of fifty thousand gallons, from which it is piped to the various 
buildings. A condensing and aerating apparatus supplies pure drinking 
water. This division is separated by more than a mile of generally 
wooded land from the sick division and the hospitals. 

There is telephonic communication between the different divisions of 
the station, and telegraphic communication with the mainland. Incoming 
vessels requiring inspection are met in the offing, and inspected immedi- 
ately upon their arrival, whether by day or night. The position of the 
station is marked by night to vessels arriving, and the working of the 
night service is facilitated by the presence of an illuminated gas buoy 
about two miles out from and opposite to the station. 



94 THE CANADIAN QUARANTINE SYSTEM. 

For the inspection service two steamers are required, one being the 
regular inspecting steamer, on duty with steam up day and night, from 
early April to late November, always in readiness to meet incoming vessels 
in the offing. She is provided with an hospital cabin, with beds, etc., for 
the landing of the sick, and with disinfecting appliances sufficient to 
disinfect a ship's hospital cabin. When infectious disease is found to 
have occurred on any incoming vessel, and to have been satisfactorily 
isolated, the sick, with their attendants, and all the contents of the ships' 
hospital are at once transferred to the quarantine steamer. The emptied 
hospital of the ship is then drenched with mercuric chloride solution, and 
treated with superheated steam. The vessel, meanwhile, proceeds up the 
river with the quarantine steamer alongside, so that even in these cases 
the delay is reduced to a minimum. 

A second steamer is required, to use as a supply boat and mail boat ; as 
a means of taking the convalescents up to Quebec when discharged from 
quarantine; to land healthy but suspected passengers for quarantine 
observation at the detention division, to act as a reserve inspecting 
steamer whenever required, and for the disinfection of vessels when the 
infection is not confined to an isolated hospital cabin as above. This 
steamer carries a sulphur dioxide blast apparatus of the most modem 
type and a tank, nineteen hundred gallons capacity, with double hose, 
etc., for drenching the vessel with mercuric chloride solution. When the 
graver quarantinable diseases are present, or isolation has not been satis- 
factory, the steamer is tied up to the vessel for the drenching of her free 
surfaces and the fumigation of holds, forecastles, and other apartments 
too large for disinfection by steam. As these processes occupy many 
hours of continuous work it is necessary to have the appliances for them 
on a separate steamer so as to leave the regular inspection boat free for 
the constant meeting of incoming vessels. 

HALIFAX, N. S. 

Halifax has been fitted with quarantine appliances, hospital and 
detention buildings to make it a station of the first class. The station is 
situated on Lawlor's Island, near the entrance to the harbor, and five 
miles distant from the city. It is about one mile in length, a quarter of a 
mile wide, and covers nearly two hundred acres. It is divided into three 
sections. On it are two hospitals, steward's residence, outbuildings, etc 
From its position behind McNab's Island, it is scarcely visible when 
entering the harbor. 

A system of quarantine and a health officer for the port of Halifax 
existed for a period of some forty years prior to confederation. In x866 
a number of cholera patients were landed on McNab's Island, where 
several hundred died, the health officer attending them falling also a 
victim to the disease. No regular quarantine station then existed, but 
the provincial government, under the stress of this visitation, at once 



THE CANADIAN QUARANTINE SYSTEM, 95 

arranged for the purchase of Lawlor's Island, which, however, was not 
completed until confederation had taken place, and Lawlor's Island, 
Halifax, was established as a quarantine station by order in council, 25th 
of May, 1868. 

Owing to Halifax being the winter port of the Dominion this is a very 
important station. The buildings on it, though old, have been repaired, 
and new detention buildings are being erected. The old wharf, or landing 
place, is insufficient for present service, and a new wharf on or near which 
to place sulphur blast and steam disinfector, is about to be erected. 

ST. JOHN, N. B. 

This station is situated on Partridge Island, some three miles below 
the city of St. John. The buildings on this have been placed in repair ; 
a steam disinfector, especially procured from England, has been placed 
in position, and a dioxide sulphur blast and appliances for the mercuric 
drench are also being supplied, rendering this quarantine efficient for 
service. 

Partridge Island was selected for a quarantine station by the provincial 
government in 1809, when it was granted under charter to the city and 
corporation of St. John, with certain provisions to be carried out by the 
city, but it was not until 1830 that it was made use of. A '< pesthouse " 
on the Carleton side of St. John river had until that date been the point 
to which infectious diseases had been transferred. In 1 883-^84 a marine 
hospital was built and efforts made to alleviate the condition of the sick, 
left from time to time, on the island. In 1847, when ship fever developed 
itself in great malignity, Partridge Island was divided into a healthy and 
an infected district. Records show that 3,000 persons were landed there 
during the year, out of which number 1,500 died from fever. In 1868, 
after confederation, an order in council was passed establishing it as a 
quarantine station under Dominion regulations. 

SYDNEY, N. S. 

This station occupies about two acres of land at Point Edward, situated 
about midway between North Sydney and Sydney proper. This station 
has no approach by land, right of way not yet having been procured to it 
through adjoining property. 

It, however, is accessible at all times by water, unless during a few days 
in the spring when floating ice accumulates off the quarantine wharf. 
The buildings at this station have been repaired, and are in fair condition. 

Sydney was established as a quarantine station by order in council, 
October 30, 1880. 

CHARLOTTETOWN, P. E. I. 

This station is distant about two miles from Charlottetown, and is 
located at the entrance of the harbor. The property covers nine acres 



g6 THE CANADIAN QUARANTINE SYSTEM. 

in extent, and the building thereon is used both as a hospital and as a 
caretaker's dwelling. 

Charlottetown was established as a quarantine station by order in 
council, July, 1875. 

PICTOU, N. s. 

This station is situated about five miles below the town of Pictou, and 
covers thirty-five acres of land. The buildings have recently been re- 
paired, and are now in proper condition. There is an hospital and 
steward's house, built of wood, and a small pesthouse, built of stone. 

Pictou was established as a quarantine station, by order in council, i8th 
October, 1873. 

CHATHAM, MIRAMICHI, N. B. 

This station is on Middle Island, in Miramichi river, distant from the 
town of Chatham between one and two miles. The buildings consist of 
two hospitals and a caretaker's residence, and are built of wood, on stone 
foundations, and are in good condition. 

Chatham was established as a quarantine station, by order in council^ 
8th October, 1886. 

PORT HAWKESBURY, N. B. 

At this station inspection of vessels, when needed, is carried on by the 
inspecting physician, appointed by the government for that purpose. 

Port Hawkesbury was established as a quarantine station, by order in 
council, 2d August, 1886. 

BRITISH COLUMBIA. 

Williams Head is to be joined to Albert Head, for a general quarantine 
station for British Columbia, and to be fitted up with the disinfecting 
appliances of the first class; together with deep-water wharf and the 
necessary buildings. 

UNORGANIZED QUARANTINE STATIONS. 

At every port at which there is no regular quarantine station the 
collector of customs at each port is the quarantine officer for the purposes 
of the regulations; and every such port is designated an unorganized 
quarantine station. 

Every vessel arriving at an unorganized station from an infected port, 
or on board of which any death from infectious disease or outbreak of 
infectious disease has occurred during the voyage, remains outside until 
it receives permission to enter from the quarantine officer. 

All the regulations applicable to regularly organized quarantine stations 
also apply to every unorganized quarantine station in so far as circum- 
stances will admit, and particularly the provisions relating to inspection,. 



THE CANADIAN QUARANTINE SYSTEM, 97 

anchoring or mooring, disinfecting, customs clearance, putting back to sea 
before breaking bulk, questions to ship's surgeon or officers, and 
penalties. 

UNORGANIZED INLAND QUARANTINE STATIONS. 

Every inland port on the frontier of Canada between the Atlantic and 
Pacific oceans, at which there is a collector or a sub-collector of customs, 
for the purpose of the regulations, is constituted an unorganized inland 
quarantine station. 

Every collector or sub-collector of customs at every such inland frontier 
port is the quarantine officer. 

Any collector or sub-collector of customs in his quality of quarantine 
officer at any inland unorganized quarantine station in Canada, if he is 
informed of or has reason to suspect the presence of any of the graver 
quarantinable diseases recited in section 20 of these regulations, shall, in 
time of cholera or other epidemic disease, order a medical inspection to 
be made of the car, carriage, vehicle, boat, or thing bringing such disease ; 

(a) And such quarantine officer is empowered to detain such car, 
carriage, vehicle, boat, or thing, until such medical inspection shall have 
been made to his satisfaction ; 

{b) A medical man making such inspection by order of the quarantine 
officer, while engaged in such service, is the quarantine medical officer. 

The customs collector or sub-collector, in his quality of quarantine officer, 
on the report of the medical quarantine officer, in a time of epidemic 
disease, in the event of any of the graver quarantinable diseases being 
found, causes the detention of the car, carriage, vehicle, boat, or thing, 
bringing any person ill with such infectious disease until the requirements 
of the regulations are in his judgment satisfied ; 

(c) Any sick person is not allowed to enter Canada until in the opinion 
of the medical quarantine officer he or she can safely do so ; 

(d) Any car, carriage, vehicle, boat, or thing, bringing such sick person 
to the frontier has the option of returning as an alternative to quarantine 
detention; or 

(f) The customs collector or sub-collector in his quality of quarantine 
officer in his discretion, on the report of the quarantine medical officer, 
causes the removal and isolation of such sick person in any car or boat, 
set apart for that purpose, or in any suitable building sufficiently separated 
from other buildings to prevent contact. 

And such quarantine officer may cause the disinfection of the car, car- 
riage, vehicle, boat, or thing bringing snch sick persons, by means of sul- 
phurous fumes, or any other mode of disinfection prescribed in these 
regulations adapted to the circumstances of the particular case. 

In the event of cholera or other epidemic disease prevailing in any part 
of the United States, through whidi a railway crossing the frontier of 
Canada runs, the governor in council may, on an order published in the 
Canada Gautte, or in an extra of the Canada Gazette^ made on a report 



98 THE CANADIAN QUARANTINE SYSTEM. 

of the minister of agriculture, and where there may not happen to be at 
that point of the frontier any adequate quarantine arrangements and ap- 
paratus to cope with an inroad of such epidemic disease, direct the 
complete cessation of passenger traffic at such point ; or such restriction 
thereof, as may in the circumstances be deemed advisable. 

GENERAL PROVISIONS. 

Every quarantine officer at a quarantine station in Canada, and every 
customs collector in his quality of quarantine officer, is, for the purpose of 
the regulations, a justice of the peace in virtue of the provisions of section 
5 of the act respecting quarantine, chapter sixty-eight. Revised Statutes. 

Within the meaning of the regulations, an infected port or country is a 
port or country where Asiatic cholera, or other epidemic disease, has been 
communicated to one or more persons through the medium of an infected 
person, personal effects, or otherwise. A port or country is not con- 
sidered infected when a single case or a small number of cases has been 
imported and the disease has not been communicated from such cases. 

Every vessel arriving from any port outside of Canada (liable to quar- 
antine) is inspected by a duly appointed quarantine officer, and is not 
allowed to make customs entry at any port in Canada until it has received 
a clean bill of health. 

No person is allowed to land from any vessel until such person is 
declared by a quarantine officer free from infectious disease, and until in 
the judgment of such officer, such landing can be effected without danger 
to the public health. 

The graver quarantinable diseases are, Asiatic cholera, small-pox, 
typhus fever, yellow-fever, and the plague; the minor, scarlet-fever, 
enteric fever (typhoid), diphtheria, measles, and chicken-pox. 

(a) In addition to the above recital, it is the duty of every quarantine 
officer to satisfy himself as to the presence or absence of any other con- 
tagious or infectious disease ; 

{b) And with respect to leprosy, it is the duty of every quarantine 
officer, particularly on the Pacific coast, to satisfy himself as to the fact 
of the presence or absence of such disease among the passengers, and in 
the event of any case of such disease being found, the person affect- 
ed is not allowed to land, but must be taken back by the vessel to 
the place whence he or she came. 

Every passenger is required to furnish evidence to the satisfaction of a 
quar'antine officer of having been vaccinated, or having had the small-pox. 

The production of a certificate by a ship's surgeon, called a " protection 
card," and his testimony under oath verifying the truth of such certificate, 
may be taken by a quarantine officer as evidence of such vaccination and 
protection. Such quarantine officer shall, however, from time to time, make 
personal examination of holders of such certificates to satisfy himself of 
the manner in which they have been issued. 

Any person not having shown satisfactory evidence of having been vac- 



THE CANADIAN QUARANTINE SYSTEM. 99 

cinated, or of having had the small-pox, is vaccinated by a quarantine 
officer ; or in the event of refusal, is landed at the quarantine station^ 
subject to detention for observation, and the expense of maintenance of 
such person during such detention is charged against the vessel. 

(a) A vessel arriving at any quarantine station in Canada will be less 
liable to detention if the vaccination of all steerage passengers not showing 
proof of vaccination within seven years is insisted on before embarkation. 
The ship's surgeon should satisfy himself of such fact in the case of every 
passenger early during the voyage, or at the time of embarkation if possi- 
ble, in order to be able to answer the questions put to him by the quaran- 
tine officer. 

In the event of small-pox having occurred on any vessel, every person 
on board not showing satisfactory evidence of having been vaccinated 
within seven previous years, or of having had the small-pox within that 
period, is vaccinated by or under the supervision of the quarantine officer ; 
or in the event of refusal, is landed at the quarantine station, subject to de- 
tention for observation, and the expense of maintenance of such person 
or persons during such detention is a charge against the vessel. 

The quarantine officer examines the surgeon or any officer of any vessel, 
under oath, touching the state of health of such vessel and every person 
on board, in the form of the questions appended to this paper. 

Every vessel provided with an isolated hospital for men, and another 
for women, on the upper-deck, ventilated from above and not by the door 
only, is in the case of minor quarantinable disease, if the quarantine officer 
is furnished with satisfactory evidence that such hospital accommodation 
has been promptly and intelligently made use of, allowed to proceed 
after the landing of the sick and the disinfection of such hospital as has 
been used; any vessel, however, arriving with any infectious disease, 
without having such special isolated and ventilated hospital accommoda- 
tion, or if having it^ without satisfactory evidence that it has been promptly 
and intelligently made use of, is liable to be detained for disinfection at a 
quarantine station. 

In the case of a vessel carrying Her Majesty's mails and arriving by 
the St. Lawrence, clearance certificate is from a quarantine officer at Rim- 
ouski or Grosse Isle, and in the case of every other vessel from Grosse 
Isle only, — 

{a) With the exception that during a time of cholera or other epidemic, 
the permission to a mail steamer from an infected port or country to land 
passengers at Rimouski may be suspended by direction of the minister of 
agriculture ; 

(Ji) And in such conditions the mails only to be landed at Rimouski, 
the vessel to proceed to Grosse Isle for inspection ; 

(r) In the event of cholera having occurred on board of such vessel 
during the voyage, the outer bags containing the mail matter to be left on 
board the steamship for disinfection at Grosse Isle. 

During a time of cholera epidemic the luggage of immigrants by every 



lOO THE CANADIAN QUARANTINE SYSTEM. 

vessel arriving by way of the St Lawrence, not disinfected at Grosse Isle, 
whether from an infected or healthy port or country, by direction of the 
minister of agriculture, is disinfected at the Louis embankment, Quebec, 
with the exception that the luggage of those immigrants booked by the 
Grand Trunk Railway may be disinfected at the Grand Trunk wharf at 
Ldvis. 

(a) The clearance granted by the quarantine officer is conditional on 
the landing of immigrants and their luggage for disinfection at the 
Louis embankment or L^vis. 

(b) The supervising officer of such disinfection counts the immigrants 
as they land, and if he finds the number tallies with that marked on the 
clearance of the quarantine officer, and has satisfactory evidence that all 
their luggage has been landed with them, he punches the clearance at the 
place marked for that purpose, which then becomes valid for customs 
entry. 

Hiis has been scrupulously carried out throughout this season. By 
request of the United States government, cordially acceded to by the 
government of Canada, officers of the United States Marine Hospital 
service have been stationed at Quebec and Lfevis. These officers have 
continuously and closely watched the processes of disinfection, and have 
fidly endorsed them, not only verbally, but by the practical method of 
putting on the disinfection certifying tags of their government as soon as 
the Canadian ones have been affixed. For affixing the tags, wire with a 
lead seal is used by both services, as a safeguard against substitution or 
accidental loss of the tag. 

Every maritime quarantine officer punches each immigrant *' interna- 
tional passenger certificate " where such are in use, in such manner as to 
convey to inland health officers the result of the quarantine inspection, as 
provided by such card or certificate. 

(a) Every maritime quarantine officer punches the schedule list of im- 
migrants by destination, province or state (if destined for the United 
States) where such is in use, which is furnished by the ship's surgeon on 
forms supplied by the government, and forwards such lists forthwith to 
the secretary of the board of health in the province or state to which 
such immigrants are destined. 

Passengers, for the purpose of the regulations, are divided into two 
classes, cabin and steerage. Steerage passengers are those occupying 
compartments other than those of first and second cabin. 

Passengers during a period of epidemic disease, are notified by steam- 
ship agents to dispense as far as possible with luggage that may be in- 
jured by wetting, in case of having to undergo disinfection — such as 
fabrics, of which the dyes are likely to run, as the owners will be com- 
pelled to assume all risks of injury. 

Vessels during a period of epidemic disease should dispense as far as 
possible with woollen hangings, curtains, carpets, and upholstering, sub- 
stituting non-absorbing coverings. 



THE CANADIAN QUARANTINE SYSTEM. lOI 

Every vessel carrying cargo, and liable to be disinfected, should have 
provided a plain frame shaft allowing a clear inside space of twelve inches 
each way, placed in the main hatch, in a sailing vessel, and one in each 
hatch of a steam-ship, divided by bulkheads, — ^the frame work in this 
shaft to be set before loading and to extend from the hatchway to the 
bottom of the vessel. This simple arrangement would receive the 
fumigating pipe and avoid shifting cargo. 

Rags coming from a port or country in which infectious disease prevails, 
are prohibited, and the names of any port or country so infected, are from 
time to time published in the Canada Gazette: 

(a) Rags arriving from prohibited ports at a quarantine station are 
liable to be burnt or otherwise treated on the order of the minister of 
agriculture, based on a report of the quarantine officer. 

New merchandise in general is accepted without question. 

METHODS OF DISINFECTION. 

The methods of disinfection at the quarantine stations of Canada are 
as follows : 

(a) Escposure to steam not less than thirty minutes, steam to be of the 
temperature of not less than loo® Centigrade (212** Fahrenheit) nor 
greater than 115® Centigrade (239® Fahrenheit); 

(d) Articles that would be destroyed by the above method to be disin- 
fected by thoroughly wetting with a solution of mercuric chloride, of one 
part to one thousand, or approximately one drachm to one gallon, wine 
measure, applied by means of a brush, or by drenching, or by immersion ; 

(c) Where sulphur dioxide is used it is to be provided by burning not 
less than three pounds of rolled sulphur per one thousand cubic feet of 
space, or if it is used in liquid form in the same proportionate strength, 
and the period of exposure to be not less than six hours. 

The disinfection of iron vessels is as follows, as may be required : 

(a) Holds — After mechanical cleansing, the hold to be thoroughly 
washed with an acid solution of mercuric chloride, i to 800 (mercuric 
chloride i part, hydrochloric acid 2 parts, water 800 parts), applied 
to all surfaces by means of a hose. If danger is apprehended from the 
poisonous efiEects of the mercury deposited on the surfaces, it can be sub- 
sequently washed down with clean water ; 

(p) Steerage — The same treatment is given to the steerage as to the hold, 
but when there is a steam-pipe provided for each compartment (for the 
prevention of fire), steam disinfection of the steerage is practised. The 
temperature in all parts of each compartment to be not less than 100^ C. 
(2i2**Fahr.); 

if) The forecastle or apartment for crew — ^After mechanical cleansing, 
the application of mercuric chloride in the manner hereinbefore prescrib- 
ed, or sulphurous fumes, or steam disinfection, if facilities ar^ provided 
for the same ; 



I02 THE CANADIAN QUARANTINE SYSTEM, 

(d) Officers^ quarters^ cabitiy staterooms^ etc, — Each compartment to 
receive die same treatment, under the same conditions, as hereinbefore 
specified, it being borne in mind that the decorative metal work in cabins, 
saloons, etc., would be injured by the use of the mercuric chloride solu- 
tion, and therefore, in such cases, other forms of disinfection are used as 
determined by the quarantine officer. 

The disinfection of wooden vessels is as follows, as may be required : 

{a) Fumigation by sulphur dioxide made by burning not less than three 
pounds of rolled sulphur to each i,ooo cubic feet of space ; or by the use 
of liquid sulphur dioxide in the same proportionate strength ; and the 
period of exposure to be not less than twenty-four hours. 

{V) Washing or flushing with acid solution of mercuric chloride (i to 
800). Cabins, forecastle, and other apartments to be thoroughly washed 
with bichloride solution, and all clothing, bedding, curtains, etc., to be 
subjected to steam for thirty minutes at from 100° C. (212° Fahr.) to 
"S° C. (239° Fahr.) 

In all classes of vessels, the bilges are first flushed with sea or river 
water, pumped out, and then treated with acid solution of mercuric 
chloride in large quantity, and allowed to remain in long contact. 

No quarantine officer nor other person employed in the quarantine 
service of Canada, is permitted to directly or indirectly receive or take 
any fee or private gratuity or reward for any service rendered to any com- 
pany or owner, master or crew, passenger or other person, at or detained 
in any quarantine, maritime or inland. Every person to whom the 
knowledge of any breach of these regulations may come, should forth- 
with report the same to the minister of agriculture. 

QUESTIONS TO BE ANSWERED UNDER OATH TO QUARANTINE OFFICER BY 
MASTERS, SURGEONS, OR OFFICERS OF VESSELS. 

Date, 189 . 

1. Wliat is your vessel's name and your name ? 

2. From what port and at what date did your vessel sail ? 

3. What is your cargo and whence taken on board ? 

4. Are there any rags in such cargo t 

5. Has your vessel touched at any place or places on her voyage ? 

6. Was such place or places, or any of them, to your knowledge infected 
with cholera, small-pox, plague, or any pestilential fever or disease t 

7. How many persons were on board when the vessel sailed ? 

Cabin passengers ; intermediate ; steerage ; 

cattlemen ; crew . Total 

8. State whether any person on board during the voyage has been, or 
is now, ill with any of the diseases above referred to, and if so, how many ? 

9. Has any person died on board during the present voyage, and if so, 
state all particulars ? 

10. Ha^each of the steerage passengers on board been vaccinated or 
had the small-pox ? 



THE CANADIAN QUARANTINE SYSTEM. IO3 

11. Did the vaccination of steerage passengers take place at the time of 
or before embarking? 

12. How many have you vaccinated on your present voyage ? 

13. {Questions to be asked^ in the event of small-pox having occurred 
during the voyage^ of ship's surgeon^ if such is on board,) Have you per- 
sonally, during the present voyage, examined each one of the passengers 
and crew for proof of vaccination within seven years, or of having had 
the small-pox in that period ? 

14. Did you, or any of the crew, or passengers, within your knowledge, 
land at any place or places within Canada during the present voyage ? 

15. Is there any person on board lunatic, idiotic, deaf and dumb, blind, 
or infirm, and if so, is such person accompanied by relatives or guardians ? 

16. Have you an isolated hospital for men, and another for women, 
ventilated from above and not from the passage ? 

17. Were such hospitals, or one of them, immediately made use of on 
the occurrence of disease ? 

18. Are there any other facts which, in your opinion, should be com- 
municated ? 

[Signature] Master, 

[Signature] Surgeon. 

CERTIFICATE. 

I Master^ Surgeon (here state 

whether ship^s master , or occupying another position on board)^ do solemnly 
and sincerely swear to the exactness and truth of the answers to the 
above questions signed by me. So help me God. 

Master^ Surgeon, 

Sworn before me at this day 189 . 



XXL 

DIFFICULTIES AND DANGERS THAT HAVE PRESENTED 

THEMSELVES IN THE QUARANTINES OF SEVERAL 

PORTS OF THE MEXICAN REPUBLIC. 

By Dr. DOMINGO ORVASTANOS. 
MexicOy Mexico, 

When the cholera first appeared in Europe in the summer of last yeax, 
the Superior Board of Health of Mexico, with great diligence, prepared it- 
self for the oversight of the ports and frontiers, and with this object ap- 
pointed delegates to go to the principal points ; it provided itself with dis- 
infection stoves in sufficient number ; with disinfectants, etc., and distrib- 
uted circulars that easily facilitate the intelligent execution of sanitary 
orders, even though we stumble over several difficulties and we run some 
dangers, but in exchange we acquired precious learning and we put our- 
selves in better situation for defence in the future. The principal basis 
we had for the practice of quarantines was : 

1. The declaration of the sanitary authorities at the starting-point of 
the steamer. 

2. The captain's declaration of the same steamer. 

3. The exact and complete execution of the sanitary measures for the 
local boards of health at the ports of arrival. The declaration of the san- 
itary authorities of the parting port would have a capital importance if it 
was given always by impartial persons, who, being scientific, could well 
understand all their responsibilities. The Mexican Consul at Hamburg 
sent a telegram to the Superior Board of Health, with date of the 23d of 
August, of last year, in which he said that in that city there had been 
eighty cases of Asiatic cholera, and that having the steamer Galicia 
started with clean bill of health, it would be convenient to have an exami- 
nation made of the crew in progress (one of our ports in the state of 
Yucatan). The charge d'affaires of Mexico at Brussels remitted about 
this time another telegram, announcing that there had been several deaths 
of Asiatic cholera in Ambers, and that the board of health had declared 
the disease cholera nostras, and they continued to issue clean bills of 
health. The consul referred to, from Mexico, at Hamburg, under date of 
the 24th of August, 1892, informed us of the cases of cholera that had 
presented themselves in that port. The consul asked if he would sub- 



DIFFICULTIES AND DANGERS IN QUARANTINES. I05 

ject himself only to look after the bills of health, expressing himself, 
finally, if there was not a sanitary meeting and if the signature was 
authentic of the gentlemen of that meeting, because if nothing more 
could be done, the Republic was in great danger of being invaded by 
cholera. Our consul in Ambers, under date of October 7, 1892, notified 
our board that in that last week there had been noticed a considerable 
diminution in the cases of cholera, there being declared in Ambers only thir- 
teen cases : consequently, the sanitary board of Escalda thought that could 
save bills of health. But fearing that that measure would not have the 
necessary efiEect if it was not supported by the consul residing at the port, 
the commercial administration received at the Hotel de Ville all the con- 
suls, to call their attention to the sanitary state, relative to die safety of 
the city, and to invite them to obtain from their respective governments au- 
thority to raise the quarantines imposed on Ambers. After the discussion, 
the majority of the consuls manifested that, it not being possible to form 
an exact opinion in regard to the extension of the disease, without having 
data worthy of credit, it would not be best to send to their governments 
representations of the disposition indicated by the burgomaster, and it was 
added that, having yet cases of cholera in the city, it would be premature 
on the part of the board of health to give clean bills of health, and that 
the consuls could not accept them ; but, according to their own observa- 
tion, they would continue to consider the port as suspicious. As it is 
seen by recent events, that I have just quoted, the authorities have some- 
times great diligence in hiding the existence of any epidemic disease ; the 
captains of the steamers are the ones who try to deceive the sanitary 
officers of the arriving ports. 

I could quote several events, but this would enlarge very much this 
paper, and I will limit myself to refer to only one. In the month of 
October, last year, there arrived at Coatzacoalco the English steamer 
Mayy coming from Veracruz, and on making the sanitary visit, it was 
found with a clean bill of health and not a single sick person on board, 
accordingly, it was allowed free intercourse. Afterwards it was known 
that in the hospital of the railroad company of the Isthmus, and at the 
solicitation of one captain of the steamer, they had taken four sailors 
attacked with what was called bilious fever, but which was nothing else 
than yellow-fever; which extended itself in various populations of the 
Isthmus. But if the authorities of the starting-ports, or the captains of 
the steamers, are sometimes inclined to diminish the importance of any 
epidemic, even to hide its existence, the local authorities of the ports 
of arrival are inclined, on the contrary, to exaggerate the dangers and to 
see great risks where certainly there are none. 

In the month of September last year, when there was cholera in several 
steamers at the quarantine of New York, there started from this port, 
direct to Progress© and Campeche, the steamer Orizaba, This steamer 
had not been in communication with any infected steamer, and it was 
believed that it would not have any cholera germ, as there had not been 



I06 DIFFICULTIES AND DANGERS IN QUARANTINES. 

reported any case of this disease in the city of New York ; nevertheless, 
the sanitary board of Campeche resolved not to allow the steamer to 
enter the port, and reported to the Superior Board of Health that they had 
taken this determination : ist, because it did not have the funds to prac- 
tice the complete disinfection of the merchandise ; 2d, because the local 
authorities did not permit the landing of the people that were on board ; 
and 3d, because the body of magistrates and a great number of the people 
from the city came to the board, begging it not to permit the entrance of 
said steamer. In this case of the steamer Orizaba^ the incorrect conduct 
of the sanitary board of Campeche could not give rise to serious conse- 
quences, but it is also possible that in determined cases the local interests 
of any port or state would allow certain dissimulation, or tolerate with prej- 
udice the interests of the federation. In view of these events which are re- 
ferred to, and of several others, the board of health have modified radically 
their system of defense ; it is not yet conformable with the well verified act 
of the consul in the bills of health, but they still demand the necessary pre- 
cautions under the responsibilities of the same consul. The declaration 
of the captain of the steamer is not taken, but the board's delegate must 
make a personal inspection of the steamer. Finally the state boards have 
no more power relative to quarantines but only the president of the Re- 
public, and he always acts as the Superior Board indicates ; in short, the 
Superior Board of Health is the centre where all news goes, that oppor- 
tunely the consuls remit, or the special delegates that the board has in 
each of the ports; and it is also the centre from which they dispatch 
all their decisions. 

The Superior Board can make use of the telegraph and mail without 
any fee, and all the affairs travel with great rapidity. 

The results obtained have convinced us of the extraordinary benefits 
that result to the Republic from centralizing its sanitary administration, 
making all the states one to wrestle with advantage against the invasion 
of an epidemic. 



XXII. 

QUARANTINK 

By S. R. OLLIPHANT, M. D., 

President of the State Board of Health, 

New Orleans^ La, 

Owing to ill health, I have been unable to prepare an elaborate paper 
on quarantine. Yet I will not let this opportunity pass without submit- 
ting a few reflections on this all-absorbing subject. As an evidence that 
the science of quarantine is deficient, not coming up to the standard that 
we, as physicians and sanitarians, would like for it to, nor meeting the 
demand of the general public, I have only to cite the wide-spread appre- 
hension of the populace in times of threatened danger, and the efforts of 
national legislation, looking to the perfecting of quarantine measures. We 
will all admit that not only quarantine, but sanitarian science in general, 
is far from being perfect. They are progressive. We know to-day much 
more about sanitation than we did a few years ago. Ten years ago we 
could not combat with disease as we can at the present time. In the 
early days of quarantine, when vessels were detained forty days, the sani- 
tarians had no ideas of anything else but time as a preventative against 
the importation of disease. They had crude ideas as to the cause of 
disease. 

They did not conceive of a living organism, or, as we call it, a germ, 
whose tenure of life or powers of propagation under favorable conditions 
may be protracted to a much longer period. In the quarantine practices 
of the present day, we do not depend on time as a factor in destroying 
this germ, and only detain people to await the development of disease 
in person. We depend on germicides to kill the germs, and render such 
articles as has been properly treated harmless at once. The germs that 
may have entered the system of a person cannot be reached and destroyed. 
Hence, the necessity for the detention of people such a length of time as 
will cover the incubative period of the disease. Even here, some of our 
progressive thinkers hold out the hope, that with the advancement of 
prophylactic medicine, we may be able to destroy the germ in person, and 
prevent its further development. With the experience of the past, we are 
justified in believing that we can take an infective article, be it ship or 
clothing, and disinfect it, and render it as harmless as such article was 
before it became contaminated. You might ask then. What more is 
needed, or can be expected, of quarantine ? 



I08 QUARANTINE. 

The answer is, that quarantine is far from perfect ; it is progressive, and 
the means we employ to-day, ten years hence may appear crude and 
obsolete. With our present means, I believe we can do all we claim, 
provided our applications are thorough ; but any one could fancy a sup- 
posititious case and see with what ease our strictest regulations could be 
evaded. Even in times of war blockades are often run. Then, again, in 
our excessive care, may we not be too hard on commerce ? Do we not 
treat severely now, many things which, with the enlightenment of the future, 
we may realize as harmless and not likely to convey the germs of disease ? 
Ten years ago the period of detention of vessels from tropical countries 
was ten days, now it is only three days, a saving of seven days to a 
ship, and with some of these large ships, seven days' detention represents 
quite a sum of money. While we are progressing, this is a matter of such 
vital importance, that it behooves us to make haste slowly, and be sure we 
are right One serious error in my section of country would do more harm 
to the confidence we have established in quarantine, than ten years' subse- 
quent success could repair. What are we to do to encourage this pro- 
gressive spirit, and at the same time guard against reckless and danger- 
ous innovation ? I think nothing so conducive to this object as our 
annual conventions, like the present one, where the representative health 
authorities come together and discuss all subjects bearing on sanitation, 
and criticise in a friendly way the methods of the various states. We all 
return to our homes with not only a knowledge of what our neighbors are 
doing, but also with new ideas by which we can improve on our own 
work. We help each other. By thus cooperating, I am sure we will 
sooner reach the ideal quarantine system than by any other means. 

What can the national government do to facilitate this work, and 
thereby secure us against the introduction of disease in our midst ? It 
can do a great deal. It can send medical representatives to foreign ports 
where infectious disease may exist, as it has done this past season, as Dr. 
Jenkins did last year, and as the Louisiana State Board of Health has 
done for the past several years, and in this manner inform all state authori- 
ties of all possible dangers. Through its consular service it can keep us 
posted as to the health status of all parts of the civilized world. The 
publication of the Weekly Abstract by the Marine Hospital Service has 
been of immense service, and should be assisted in its usefulness by the 
various states contributing their health reports for publication. The 
national government could delegate agents, selected with regard to their 
special aptitude and training for the purpose, under the supervision of 
the Marine Hospital Service, or other medical branch of the government, 
to go to countries where infectious disease exists, and there make a spec- 
ial study of the etiology, prophylaxis, and treatment of those diseases, and 
other agents in the field of bacteriology and in the chemical laboratory 
could do great service, not only to the practical sanitarians, but also to 
science and to the human race. The United States is able and ought to 
undertake this work, and disseminate knowledge for the good of the peo- 



QUARAimi^E. 109 

pie. The United States government cannot legislate disease out of 
existence, nor can it exclude it from our country — as it is trying to do with 
the Chinese — ^by legislation, except by the assistance of the individual 
states. There is bound to be a personal interest and a personal respon- 
sibility to the people affected, to secure proper vigilance and enforce- 
ment of quarantine regulations. The assistance suggested could be 
supplemented by aid in special instances where requested, as in the case 
of Brunswick, Georgia, at the present time. If the government would 
render the assistance indicated, its attitude to the individual states could 
not be complained of by the most exacting advocate of paternalism. 

The relations of states to each other, and of countries to each other, in 
quarantine matters, is a subject I think should be considered. In times of 
threatened invasion by epidemic disease, ought a state or country to look 
only to its own safety, regardless of states and countries beyond it ? Is 
it humane ? Is it good policy? Would not such practice result in endan- 
gering said territory from the rear, as well as from the front, should it 
pass epidemic disease through its borders, under guard, into an adjoining 
state ? The principle of protecting self only is too narrow, and not suf- 
ficient to cover the necessities of quarantine. New York, by acting on 
such a principle, could infect every state in the Union. Suppose people, 
with their effects, from cholera-infected ports of Europe, were allowed to 
pass through the state of New York, under quarantine guard, to the state 
of their destination. How long would it be before the whole country would 
be infected with cholera? The same principle applies with increased 
force to yellow-fever in the southern section of this country. In protect- 
ing ourselves, we should give the same guaranty of safety to those beyond 
us ; otherwise, we might be flanked in our efforts at safety and selfishness, 
and finally have to quarantine ourselves in against all siirrounding 
countries, which would be but little more desirable than being hemmed in 
by the quarantine of other states. If, for instance, Louisiana, in her sel- 
fish efforts to protect herself against the introduction of yellow-fever, we 
will say from Brunswick, Georgia, should declare that persons or baggage 
from said place, not destined for the state of Louisiana, would be allowed 
to pass on through, we will say, imder the guard of quarantine officials, to 
the farthest limit of Louisiana. We might feel for the time a sense of 
safety, but suppose, in the meantime, Texas should become infected, then 
Arkansas and Mississippi, where would Louisiana be ? She would have to 
shut herself up against the outside world, or, what is more probable, the 
disease, surrounding her on all sides, would soon gain an entrance, then 
she would suffer all the misery and effects of a general epidemic. We 
should combat disease as a well organized army, bringing in reinforce- 
ments and falling back, contesting every step, only as the enemy forces 
an advance. Say Georgia is infected from the south-west ; Alabama is 
the first threatened state. If she enforces proper quarantine, what is the 
use of Mississippi, Louisiana, and Texas going to great expense and dis- 
play of apparent vigilance, when they are protected by intervening states 



no Q UARANTINE, 

that enforce, we will say, the same strict quarantine approved by us all ? 
The territory is continuous. Could we not imagine our state line to 
extend to the border, where there is necessity of strict watch ? Had we 
perfect confidence in each other, we could and would. The quarantine 
of states at a distance from the point of danger, with non-infected states 
intervening, is like striking in the dark, and serves to bring quarantine 
methods and practices into ridicule. Should a state deem the quarantine 
practices of another state not sufficient protection, let that state send a 
representative of its own, to that suspected quarantine, with instructions 
to keep his own health authorities informed and to warn against the ship- 
ment of undesirable passengers and freight. Louisiana will, at all times, 
cheerfully give the representative of another state health authority every 
facility for inspecting her methods, and will have no fear of criticisms he 
may make. 

A town once becoming infected should not be depopulated hastily and 
without system. The sick should be strictly isolated and the well should 
be detained at stations for the purpose, a sufficient length of time to cover 
the period of incubation of the disease, after having previously had all 
their effects disinfected, and then, when they left, a certificate setting 
forth the above facts should admit them into any community. Recogni- 
tion of such certificates would be justifiable only when party issuing said 
certificate is known to be thoroughly competent, reliable, and conscien- 
tious. Even where only one or two cases have developed, this method of 
allowing inhabitants to leave gradually and systematically is to be recom- 
mended. It would obviate the panicky feeling throughout the country, 
and work much less hardship to the people themselves. Commerce and 
travel would be relieved of much burden and interruption, and the danger 
of the spread of disease would be reduced to a minimum. 



XXIII. 

THE QUARANTINE SYSTEM OF TEXAS. 

By R. M. SWEARINGEN, M. D., 

State Health Officer, 

Austin^ Texas, 

Texas is believed to be unique in the organization of her Public Health 
department. Unlike other states, it was not created by a single act, nor 
is it operated through a board of health. It has been the growth of 
years, evolved from a rudimentary beginning. 

The legislature at nearly every session since 1849, ^^ ^^^^^ appealed 
to by prominent physicians to enact a law creating a state board of 
health, but for some reason these praiseworthy efforts have not been suc- 
cessful. In lieu thereof, cities and towns and county commissioners' 
courts were clothed with authority to make and enforce sanitary regula- 
tions, and a coast quarantine under the jurisdiction of local port authori- 
ties was instituted. 

The yellow-fever epidemic of 1878 showed the weakness of such defen- 
ces, and at the same time exhibited the strength and barbarism of the 
shotgun contingent that has from immemorial days supplemented prim- 
itive and inefficient sanitary laws. Epidemics are hard schools, but they 
teach wise lessons, and the one referred to was not altogether lost upon 
our law-makers. 

In 1879 Dr. R. Rutherford, who had, the previous year, rendered valued 
services to the state as health officer at Houston, assisted by Dr. J. T. 
Fry, an intelligent physician then in the legislature, secured the enactment 
of a law which remedied some of the existing defects, and became the 
basis of the present system of quarantine. This law made the governor 
the head of the department, and authorized him to appoint a state health 
officer and all other officers needed to execute the provisions of the act, 
and to dissolve local quarantine when unnecessary. 

Dr. Rutherford was appointed state health officer by Governor O. M. 
Roberts and under his management stations were built, and the law put 
into operation. Two years later the present incumbent succeeded Dr. 
Rutherford as state health officer. During the first four years' trial of 
the law the state was free from invasion by dangerous diseases, and no 
faults in the construction of the system were made apparent. In the 
summer of 1883, however, yellow-fever made its appearance in Matamo- 
ras, Mexico, and came thence into Brownsville, Texas. This afforded 



112 THE QUARANTINE SYSTEM OF TEXAS, 

opportunity to test the efficiency of the new law, and it was found to be 
defective. Local health boards had co-ordinate authority with the state 
health officer, and could, and actually did, put that officer in quarantine 
and held him there at their pleasure. Not even the governor had power 
to release one so held, till the officer in command of the guard gave the 
order for this release. 

This defective link was, at the suggestion of the present state health 
officer, amended in 1883, and authority given the governor and the state 
health officer to control all subordinate officers, and to make rules for 
their guidance. With this amendment the machinery of the public health 
department worked satisfactorily, imtil the winter of 1889 and 1890. 
During that period in nearly all the cities and counties of south and 
south-west Texas, and even in central parts of the state, small-pox pre- 
vailed to an alarming extent. At one time we bade fair to rival our neigh- 
bors across the Rio Grande ; but after a protracted struggle vaccination 
and isolation were triiunphant. 

The trial of the law again revealed grave defects. There was no plan 
for giving prompt information, nor for enforcing uniform action. Suffi- 
cient power had been given the governor and chief health officer, but 
the amended law failed to define the respective duties, powers, limitations, 
and financial responsibilities of state, town, and county. As a consequence 
of this omission, every community visited by small-pox looked to the state 
to be re-imbursed in money expended in caring for those sick of small- 
pox, and claims for expenditures were sent in, which, if paid, would have 
well nigh wrecked the state treasury. Thus was demonstrated the neces. 
sity for still another revision of the law. 

In obedience to a request from His Excellency Jas. S. Hogg, governor 
of Texas, the state health officer prepared a bill which, on the 29th of 
April, 189 1, became the law of the state, and is now in operation. It 
vests in one officer authority given by other states to boards of health and 
while perhaps wanting in the combined wisdom of boards, the loss is com- 
pensated in a measure by prompt action and individual responsibility. It 
clearly defines the duties, and prescribes the powers and jurisdiction, of all 
health officials ; and the financial obligations of the state and of towns and 
counties for the expenses of quarantines are definitely fixed. The offi. 
cials provided for by the act are, a state health officer, state quarantine 
officers, and state quarantine inspectors, all commissioned by the gover- 
nor. The first mentioned are designated as "permanent," the others? 
" temporary." There are six quarantine officers in the service at present, 
and during the yellow-fever quarantine season, from May i to Novem- 
ber I, each year, they are on duty along the gulf coast at the following 
ports of entry: Sabine Pass, Galveston, Pass Cavallo, Aransas Pass» 
Velasco, and Brazos de Santiago. The temporary quarantine officers are 
stationed at the railroad crossings into the state, and certain of them, six 
in number, are assigned to duty only when, in the opinion of the state 
health officer, it is necessary to guard against inter-state infection. They 



THE QUARANTINE SYSTEM OF TEXAS. II3 

are held in readiness to go on duty at short notice, and are provided with 
tents, cots, bedding, and other necessary camp equipage, stored near their 
respective stations. The other quarantine inspectors, three in number, 
are constantly on duty, and are stationed along the Mexican border, one 
each at Laredo^ Eagle Pass, and El Paso ; and all persons entering the 
state through these stations are required to make affidavit that they have 
not been within a place infected by yellow-fever for ten da3rs, nor within 
a house infected by small-pox within a period of twenty days. 

In addition to the state officials above mentioned, there is, in each 
county, appointed by the county judge, a county physician, who has juris- 
diction throughout his county in all matters pertaining to quarantine and 
epidemic diseases, and over all local health officials. In most large cities, 
and in some smaller ones, there is a city physician, and most frequently 
both these officers are represented in one person. These officers are all 
subordinate to the state health officer, co-operate with him in the en- 
forcement of quarantine, and of such sanitary measures as may be deemed 
necessary in the interest of public health ; a roll being kept in the office 
at head-quarters. The county pays the salary of the county physician 
when engaged in official duty. The county physicians establish, maintain, 
and enforce local quarantine when declared by proclamation of the coimty 
commissioners' court, — the rules and regulations being in harmony and ac- 
cord with those prescribed by the state health officer, to whom they are 
subordinate, and make written repo];ts, giving the cause and origin of out- 
breaks of dangerous diseases, history of epidemics, with number of deaths 
and such other data as may be of statistical or scientific value. 

Galveston is by far the most important of our gulf ports. The station 
is about two miles from the city on the north side of the main channel 
leading from the bar to the city, and immediately in front of the old fort 
site. The reservation on which it is built is near the shoals of Pelican 
Island, and covers an area of ten acres. It was donated by the city of 
Galveston to the state of Texas exclusively for quarantine purposes. Ap- 
plication to the city government for the donation was made by the state 
health officer in person in the spring of 1892, and the title was given 
the same year. The quarantine buildings, which are in the centre of the 
ten acres of shoal water (averaging ten feet deep), can never be en- 
croached upon by other buildings, and will ever remain completely iso- 
lated. The wharf of the station fronts on the main ship channel, and is 
304 feet in length, with sufficient depth of water to permit the largest 
ocean steamers to come alongside. The ware-rooms are ample to meet 
all requirements, and separate rooms for males and females are provided, 
to accommodate 200 to 300 persons. There are also separate apartments 
for segregating the well persons from those who have been exposed to in- 
fection, and the isolation of the sick from all others. The arrangements 
for compulsory bathing are complete. The immigrant or candidate for ablu« 
tion enters a narrow gallery or circuitous gangway, shaped something like 
the letter S, and is compelled to go through, and emerge by another door 



114 ^^^ QUARANTINE SYSTEM OF TEXAS. 

opening into a large warm chamber. While making the journey, he (or 
she) is subjected to a heavy shower of water from sprinklers overhead. 
Before and during this performance, the wearing apparel with which those 
under treatment are to be re-clothed, is carefully labeled, and run through 
the steam-heater and thoroughly disinfected. All garments, bed-clothing, 
bedding, and other articles classed as dangerous, are placed in the heater, 
a large iron cylinder, built on the Holt system of maritime sanitation, and 
sufficiently capacious to meet all demands. An elevated cistern, contain- 
ing mercuric bi-chloride solution, enables the officer in charge to sprinkle 
the decks and wash out the holds of all vessels. 

The permanent quarantine stations, on the border and on the Gulf 
coast, give, and for many years have given, ample protection against 
yellow-fever and cholera. The long period of incubation of small-pox, 
however, necessarily eliminates the detention feature of protection, and we 
rely for safety upon the isolation of those sick with the disease, and vac- 
cination of those who have been exposed. The Rio Grande, which forms 
the boundary line between Texas and Mexico, is fordable at many places, 
and small-pox is usually prevalent in the interior of Mexico. Hence the 
impracticability of exclusion, to say nothing of detention and isolation, 
along that border, of all persons possibly exposed, is easily understood. 
An army of men could not guard against invasion of small-pox along 
the Mexican frontier under existing conditions. 

At a meeting of the American Public Health Association, held in the 
City of Mexico in November, 1892, I had the honor to present a paper 
setting forth these facts, and many others bearing upon the subject, 
demonstrating the necessity for an international sanitary conference be- 
tween the United States and Mexico. In that paper the inability of the 
Texas government to give protection to her people against such a danger 
was set forth, and a protest was made against the seeming reckless indiffer- 
ence of the Mexican officials to the fundamental principles of sanitary 
science ; at the same time, co-operating towards mutual protection was 
invited and urged. I was answered, by one of the most distinguished 
physicians and sanitarians of that Republic, that they had good sanitary 
laws but could not enforce them. Since the discussion of that paper, a 
fully developed case of small-pox was taken from the cars at Laredo, 
Texas, by the state quarantine inspector at that station, which had trav- 
elled from San Luis Potosi, a distance of several hundred miles, in an 
ordinary passenger coach filled with passengers. This and numerous 
other occurrences furnish abundant evidence that Mexican authorities 
either cannot or will not enforce essential regulations for the arrest of 
small-pox infection. 

When bandits from the western side of the Rio Grande venture to 
cross into Texas and capture cattle and horses, the war-drum is sounded, 
and squadrons spring to arms for their protection. Our government 
demands restitution, and the Mexican government admits that her laws, 
although good, have been violated, and the demands are complied with. 



THE QUARANTINE SYSTEM OF TEXAS. II5 

The laws of nations are complete and inexorable in the protection of 
property from ordinary lawlessness, but there is never restitution claimed 
for greater injuries that result from the criminal neglect of the simplest 
laws of sanitary science. The admission of inability to enforce the sani- 
tary laws of Mexico does credit to the gentleman's candor, but affords no 
protection to the Texas border. The knowledge of sanitary enactments 
by the Mexican government has probably never been disseminated 
amongst the people, and the masses are about as ignorant of their exis- 
tence as were the subjects of the ancient Roman who suspended his 
edicts so high that the people could not read them. 

Let us hope that a new order of things will soon prevail, and that the 
Mexican scientists and physicians, who compose a distinguished portion 
of the American Public Health Association, will soon diifuse the light of 
their high intelligences upon their law-makers, and that the two great 
republics, so closely allied geographically, politically, and commercially, 
may yet become the model sanitary nations of the world. 



XXV. 

CONSERVATION OF NERVE FORCES. 

By Mrs. COLEMAN STUCKERT. 

For thb Public Health Congress. 

The question has been repeatedly asked, " Mrs. Stuckert, how did you 
come to work out your plan for cooperative homes housekeeping ? " The 
answer is this : I saw that our women were faded and old before reaching 
middle age, and I knew that something was radically wrong from that. 
Women at middle age should be like a rose in full bloom. I noticed also 
that mother after mother passed over into the great beyond, leaving fami- 
lies to be raised as they might. 

I made an effort to find out why these mothers were taken so soon ; 
was it that they had a greater work to do after leaving this plane ? Oh, 
no, there could be nothing of that kind ; there could be no work of greater 
importance to be done anywhere than the training, carefully and tenderly, 
of the children under their care. I heard a physician say, speaking of a 
mother who had left a young family, "Ah ! another white slave who has 
suffered the penalty of being continually overworked ; what can be done 
to lessen the cares of wives and mothers ? " He said further, that no 
woman could wash, and no woman could endure for a long time standing 
over a hot fire in a small kitchen, and keep her strength. I then saw that 
women had fallen into a rut, and did not see the way out. 

Woman has all along believed that she must do just as her mother and 
grandmother have done before her for all time in the years gone by, but 
for many years woman has been inwardly rebelling against her seeming 
destiny. I concluded that the condition of things in the home was not 
conducive to health, harmony, happiness, or, in fact, to the accumulation 
of money for the dark day, or the rainy day, or the old age, of the 
masses. 

What could be done for the discontent? What could be done that 
marriage need not be a failure ? What could be done to make life bet- 
ter worth the living ? Show the seething, struggling masses that they can 
have homes for less money than they had ever dreamed of — homes that 
were warmed, lighted, and cared for at less cost than they had ever 
known ; food for less money, prepared by skilful cooks — specialists who 
understood the relation of food to the building up of the physical sy3tem 
by knowledge of the chemistry of the foods, the science of preparing 
them, preserving all the nutritive qualities and all the fine flavors, making 
foods palatable ; in this way bidding defiance to diseases, very largely to 
the scourge of intemperance. 



CONSERVATION OF NERVE FORCES. II7 

What cannot be done for the race by the conservation of the nerve 
forces when our women are relieved from the cares of the preparation of 
three meals a day ? What a waste of time and energy there is going on 
in every home where cooking is done by, or under the supervision of, the 
mistress of each home three times a day, day in and day out, in connec- 
tion with all the other cares of the home. 

What the other duties are that fall on the shoulders of our women 
many have never stopped to think. In many instances, in fact in the 
majority of cases, the woman in each home fills the place of wife, mother, 
housekeeper, laundress, nurse, and seamstress. 

Only think of it, we cannot hire any one to come into the home and 
fill all these places, not for money I But the places are filled by many 
mothers without a murmur, until their health is gone and their spirit 
broken. 

Why, men give mof e care to their cattle than to their wives, more care 
to stock raising than to raising their children ! This is not right, but all 
wrong. How can we have children well bom when the mother is always 
overtired, and the pre-natal conditions of the child have so much to do 
with the character? 

Tired, overworked mothers bring into the world children who develop 
into lazy, easy-going men and women, and then we wonder how it is that 
they are as they are, when our women have had every nerve strung to its 
utmost tension by the cares of the household — if not by performing all 
the labor herself, then by the supervision of all the details and a continual 
looking after inefficient servants. 

A lady, a really lovely woman, said to me, " I never knew I had a tem- 
per until I had servants to look after, and they have almost made a fiend 
of me ; my nerves are undone by the way in which I am tried." 

Physicians say there is more of the so-called female weaknesses, owing 
to the continual effort of our women to accomplish the work of three or 
four, than from almost any other cause. 

Think of how little of the best of themselves the majority of women 
give to their children: they give only the nervous, tired side. After 
spending all their energies on the housework, a child does not find in its 
mother that which its heart craves. 

The husband comes home from his battle to earn subsistence for his 
family ; he is tired, but there is often neither comfort nor rest in that home, 
for his wife has got past enduring any more, and instead of meeting . her 
husband and children with the smiles that all desire to see wreath her 
face, they become discouraged. 

The husband needs encouragement ; the wife thinks it is she who needs 
encouragement, and looks for relief by the coming home of the partner 
of her life's interests ; children are answered hurriedly, many times indif- 
ferently, even snappishly, because of the tired, nervous condition of the 
parents. Then the children become restless, and seek satisfaction in 
some other quarter, for the parents are not congenial or companionable. 



Il8 CONSERVATION OF NERVE FORCES. 

What may not be attained by mothers when relieved of the drudgery 
of housekeeping? But few mothers realize the great responsibility of 
motherhood. Mothers should not be situated so that they become nerv- 
ous and tired and irritable. 

The ejffort to get through with three days* work in one day*is wearing 
in the extreme. Then there is the continual anxiety, if there is the 
usual inefficient help in the home, for the wages paid to the help is not 
begrudged, but the waste in the kitchen is simply appalling, for it fre- 
quently costs from $20 to $30 a month more to keep the family table 
than it does when there is no help ; so that women will struggle through 
much to keep down expenses, thereby sacrificing their own health and 
the comfort of the husband and children. 

Woman's time would be better utilized in the education of her chil- 
dren, the companionship of her husband and family. Woman, the archi- 
tect of character, teaching the children, that they may take every step 
right and not have a continual imdoing to do: teaching the boys and 
girls that in every act in life they are record making, that they are build- 
ing a temple not made with hands. 

Woman at her best will know how to govern herself, and so be capable 
of governing others. In the home will be taught the true principles of 
right government: our children will go out understanding true govern- 
ment for the nation's good. Woman's government should be through 
love of good. 

See how many children, who are governed through fear, become nerv- 
ous, cowardly, untruthful, and unreliable. The woman who is at her best 
mentally will see that she can lift to the highest if she can enter into the 
pleasures and pastimes of the boys and girls ; and the woman who can 
keep up with the times, and who is dressed to receive her loved ones, 
and in a cheerful mood smiles a glad welcome, will make life twice 
worth the living. 

After looking into the life and its needs, I have worked out, with the 
hope of bettering life's conditions and saving the lives and the nerves of 
our women to an old age, the system known as the Coleman-Stuckert 
Cooperative Family Homes, of which the following is a brief outline : 

1. To minimize the drudgery of housekeeping, and to solve practicably 
the servant question ; to save money, time, and labor ; and to give, be- 
sides the comforts of a pleasant home, the mothers a chance to devote 
themselves more fully to the education of their children, and to the phy- 
sical, moral, and intellectual improvement of all concerned. 

2. Here is the sketch of the cooperative family houses. We erect a 
block of forty-four houses, varjdng in size from four to twelve rooms, 
built in Spanish, Romanesque, and Venetian style of architecture. In 
the centre of the block we have a building containing the kitchen, laun- 
dry, dining-room, and on the upper floor the entertainment hall, library, 
and kindergarten, also apartments for help. From this central building 
we will heat and light the whole block of homes. We will also have our 



CONSERVATION OF NERVE FORCES, II9 

own cold storage and ice plant. Inside the block we have two large 
courts, surrounded by a promenade. 

3. The management of the whole will be tmder the control of direc- 
tors, chosen from among the members of these cooperative homes, and 
the special control of a practical superintendent, who looks after the buy- 
ing, book-keeping, and gives general supervision to the practical working 
of the central department. 

4. There are skilled cooks, who understand the chemistry of food and the 
science of preparing it ; all the cooking will be done as a family cooking. 
All hands employed are experienced specialists in their respective depart- 
ments, taken from the best training schools, both here and abroad. The 
laundry is fitted up with all the latest labor-saving improvements, so that 
the laundry work can be done at a cost of twenty-five cents a dozen. 

5. The meals. The lady in each home is presented every morning 
with a list of the seasonable things that are in market; from that she 
selects for the three meals of the day. 

She orders what she requires, how she wants it cooked, and when she 
wants it served. It is optional whether she have it served in her home 
or in the general dining-room. We have specially adapted hampers, with 
different compartments for different shaped dishes. The roast comes in 
on the platter, vegetables in the vegetable dishes, just as they have here- 
tofore from the separate kitchens, and they are heated by a special con- 
trivance, so that everything is kept warm ; the hamper thus represents a 
portable oven. 

We have an automatic electric railroad, which is carried round along 
the back doors, and carried high enough not to interfere with any one's 
head. The hampers are lifted in by a man right into the dining-room of 
the home. 

6. There are besides many other ingenious contrivances, such as call- 
bells and speaking-tubes from every house to the central building, so that 
anything called for, such as hot cakes in the morning, will come in just 
as quickly as it does now from your separate kitchen. 

It is optional whether the ladies use their own handsome china or the 
ware belonging to the central department. In each dining-room is a cabi- 
net sink, looking like a fancy cabinet when closed, in order to enable the 
ladies to wash up their own china, otherwise they send the china back in 
the hampers to be washed up at the central department. 

7. The plan set forth above has met with the enthusiasm of the people 
all over this country, also abroad ; the press has taken it up largely. 

By special request of the authorities of the Columbian Exposition, Mrs. 
Coleman-Stuckert has delivered daily lectures in the Art Institute, Chi- 
cago, in connection with the World's Congresses. 



XXVI. 

REPORT OF THE INTERNATIONAL COMMITTEE ON YEL- 
LOW-FEVER 

Mr. President : — The committee on " yellow-fever," appointed at our 
last meeting in the city of Mexico, has the honor to report as follows : 

On January lo, 1893, the following letter was addressed to every mem- 
ber of the committee, by the chairman : 

81 EsPANADA Avenue, New Orleans, June 10, 1893. 
To Dr. \ 

Of the Committee " On the Origin, Causes, and Development of Yellow-Fever, and the 
Proper Means to Wipe it Out at iU Birth." 

Dear Doctor : — At the twentieth annual meeting of the American Public Health 
Association, held in the dty of Mexico, November 29, 1892, the president, discussing the 
subject of yellow-fever, spoke as follows : 

** The great vital problem for us, gentlemen, is yellow-fever. Are we not justified in 
hoping that our combined efforts will find out its true endemic causes and proper means 
to wipe it out ? The Mexican Gulf ports, the Antilles, the Atlantic coast of South Amer- 
ica — all reputed habitats of yellow-fever— call to-day for energetic action. We must 
smother the scourge in its very cradle. 

" We are in an era of progress. A near future will realize our hopes. The stamping 
out of yellow-fever will be the triumph of modem sanitary engineering 1 

'* To attain such a goal, which would create a new epoch for our respective countries, 
what are the proper measures and means ? Without discounting the future, I would re- 
spectfully suggest, as a preliminary step, the appointment by the Association of a perma- 
nent committee 'On the Origin, Causes, and Development of Yellow-Fever, and the 
Proper Means to Wipe it Out at its Birth.' This committee, to be composed of sanitarians 
and engineers from the different countries represented in this Association, invoking, if 
necessary, the assistance of our governments. 

" Let such a committee set to work deliberately, make an annual report of its labors, 
and in a few years I am confident we will have accomplished great results." 

In accordance with this recommendation, the Association created a committee *'On the 
Origin, Causes, and Development of Yellow-Fever, and the Proper Means to Wipe it Out 
at its Birth," and you were appointed a member of said committee. 

We hope to be able to present at the next meeting a partial report, at least, on this 
important international sanitary question, and in order to facilitate the work of the com- 
mittee, each individual member of the same is urgently requested to give full expression 
of his views on the subject, and indicate such sanitary measures and local reforms, or 
improvements, in the reputed habitats of yellow-fever, as he considers most effective to 
bring about the greatly desired object, namely, the stamping out of the scourge, in its very 
cradle. 

Sincerely and fraternally yours, 

F. Formento, M. D., 

Chairman of Committee, 



APPENDIX TO REPORT ON YELLOW-FEVER, 121 

In response to this letter, two letters were received, one from Dr. Horl- 
beck, of Charleston, and one from Dr. Lic^aga, of Mexico City. The 
latter is an exhaustive and interesting paper on the subject of yellow-fever 
as it exists in the Republic of Mexico. 

The replies of our two colleagues on the committee are hereby sub- 
mitted, as part of the committee's report. 

We respectfully request that said committee be continued, and further 
time be granted, in order to prosecute its most important object. 
Respectfully submitted, 

Felix Formento, M. D., 

Chairman. 



APPENDIX. 

REPLY OF DR. H. B. HORLBECK. 

City of Charleston, S. C, Aug. 24, 1893. 

Felix Formento, M. D., Chairman, 

Dear Doctor: — I am in receipt of your £^vor of June 10, asking me, as a 
member of the committee, ** On the Origin, Causes, and Development of Yellow- 
Fever, and the Proper Means to Wipe it Out at its Birth," for an expression of my 
views on the greatly desired object, namely, the stamping out of the scoiu-ge, in its 
very cradle. 

We do not propose to occupy your attention for a lengthy discussion of this vast 
subject, but will deal entirely practically with the matter. 

We must premise by expressing our views that this plague is not of necessity a 
denizen in its favored zone, and call to your attention hundreds of cities, towns, 
hamlets, etc., etc., in Central America, Mexico, South America, and the West 
Indies, where the disease is hardly ever seen ; and also to the fact of the entire 
freedom of these lands, previous to 1691, from yellow-fever. We well know, 
however, that they are liable at any moment to an outbreak, by the introduction of 
the infection. 

It occurs to us, as a fundamental point in eradicating this disease, to take cog- 
nizance of the infecting sources, which are forever furnishing the germs for propa- 
gation. 

There are four of these centres in the four countries of the yellow-fever zone, 
which are always affected with yellow-fever — during all seasons of the year, — 

Veracruz, Mexico; Colon, Central America; Havana, Cuba; Rio Janeiro, 
Brazil. 

If these four centres of infection could be purged of yellow-fever, a very radical 
step will have been taken in accomplishing the desired object. How to clean these 
cities is then the base-line of operations for the assault on yellow-fever, and until 
these cities are rendered free from the disease no material change can be looked 
for. The fact that there are four infecting centres present, we suggest should be 
brought to the attention of the president of the United States, and we further 
suggest that he be eamesdy requested to take such measures as he may think 



122 APPENDIX TO REPORT ON YELLOW-FEVER, 

proper, by coramunication, committee, or otherwise, with these, our governments, 
to have these cities cleaned of the presence of yellow-fever ; with enlightened san- 
itation, proper water-supply, efficient sewerage, by water-conduit, constant disin- 
fection, and continuous and proper house to house inspection, these objects may 
be accomplished. 

When yellow-fever shall have been eradicated from Veracruz, Colon, Havana, 
and Rio Janeiro, the first great step will have been accomplished. 
Very sincerely yours, 

H. B. HORLBECK. 



CONTRIBUTION TO THE STUDY OF YELLOW-FEVER FROM A 
MEDICO-GEOGRAPHICAL AND PROPHYLACTIC POINT OF VIEW 
IN THE MEXICAN REPUBLIC. 

By Dr. Eduardo Lic&aga, 
Mexico, 

At its meeting held last year, in Mexico City, the American Association of Pub- 
lic Health appointed an international committee *<0n the Origin, Causes, and 
Development of Yellow- Fever, and the Proper Means to Wipe it Out at its Birth." 

I had the honor to be named one of the members of this committee, and I have 
since received a letter from Dr. Formento, its president, in which he uses the fol- 
lowing words, — ** We hope to be able to present at the next meeting a partial 
report, at least, on this important international sanitary question, and in order to 
facilitate the work of the committee, each individual member of the same is 
urgently requested to give full expression to his views on the subject, and indicate 
such sanitary measures and local reforms or improvements in the reputed habitats 
of yellow-fever, as he considers most effective to bring about the greatly desired 
object, namely, the stamping out of the scourge, in its very cradle." 

I have copied the exact text of the words used by the president of the commit- 
tee, in order to show the manner in which we ought to enter upon the consideration 
of this important problem, with a view to a satis&ctory solution. 

If each one of the members of the committee undertakes to treat the whole of 
the question, he will necessarily have to repeat a great deal that has been previ- 
ously said by other physicians that have discussed the subject ; but if I only under- 
take the study of a limited portion of the problem, I may, perhaps, be able to 
throw some light on the subject, and with that object I now propose to present to 
the Association a brief study, containing all the information of a positive character 
which has been acquired in the Mexican republic, with respect to the following 
points: 

First. Places which we may consider as centres of yellow-fever, on the coast of 
the Gulf of Mexico. 

Second. Localities in which the yellow-fever does not originate, but which pre- 
sent favorable conditions for its development, if once it has been imported from 
any other place. 

Third. Epidemics of yellow-fever which have invaded different localities of the 
coast, specifying the causes which have given rise to the same, based on exact data 
in our possession. 



APPENDIX TO REPORT ON YELkOW-FEVER. 123 

Fourth. Immunity which is enjoyed by individuals born in places where the 
fever prevails with an endemic character, and manner in which we are to under- 
stand this immunity. 

Fifth. Inoculation of Dr. Carmona to obtain this immunity. 

Sixth. Measures of sanitary police, which I consider indispensable to prevent 
the importation of yellow-fever in those localities which ^vor its propagation and 
development. 

FIRST. 

The Mexican republic is situated to the south of the United States of America, 
and extends between the parallels of 14° and 32° of north latitude, with width cov- 
ering 30° of longitude, and an area of 2,000,000 of square kilometres. On the 
west it is washed along the whole of its coast by the Pacific ocean, which takes 
the name of the Sea of Cortez or Gulf of California in that part which separates 
the peninsula of California from the main land of the continent, and on the east 
it is washed by the Gulf of Mexico and the Caribbean sea. 

On the Pacific ocean the republic has 6,250 kilometers of coast, and 2,580 on 
the Gulf of Mexico.^ This enormous extent of coast is considered by Europeans, 
and even by Americans, to be extremely unhealthy, they having an erroneous im- 
pression that on those coasts yellow-fever originates and develops in a spontaneous 
manner. I desire to correct this error, by informing the Association that in the 
entire Pacific coast, and in 3,000 kilometres of coast on the peninsula of Yucatan, 
yellow-fever has never appeared in a spontaneotis manner. Neither has it appeared 
in the greater part of the coast that forms the Gulf of Mexico. 

I will now indicate the localities which were considered as centres of infection, 
for the reason that yellow-fever prevails in them in an endemic form. 

The city of Veracruz, in the port of the same name, occupies to-day the same 
position that it has had since the year 1599. 

The investigations which have been undertaken by physicians and historians 
have never been able clearly to determine whether the yellow-fever originated in 
Veracruz, or was imported from other parts. Many authors are inclined to adopt 
the latter opinion, and especially Dr. Charles Heinemann, a distinguished German 
physician, who for many years practised his profession in that port, and from 
whose interesting works I have taken many of the data. for this paper. ^ However 
this may be, the feet is that Veracruz, for more than two centuries, has been the 
most important hot-bed of yellow-fever in the whole coast. From this point the 
troops started in 1843, ^^o introduced the disease for the first time in the port of 
Tampico. The epidemics which ravaged the same port in the years 1847-48, and 
in 1863-64, owe their origin to the same circumstances. In the same way, the 
disease was carried to Tuxpan in the year 1863, ^^'^ ^c> Jical tepee in the years 
1861 and 1868. 

In Veracruz the greater part of the epidemics take place in the summer time, 
between March and October; but on some occasions, as in the years 1867-68, and 
in 1877-78, the epidemics raged through the winter. 

According to Dr. Heinemann, the port of Alvarado, situated eighteen leagues 
to the south-east of Veracruz, and near the mouth of the river Papaloapam, is 
another centre of the disease. 

iLos Estados Unidos Mexicanos, etc. R. de Zayas Enriquez. — 1893. 

>Estudios sobre la Fiebre amarilla en la costa oriental de la RepuUica Mexicana por el Dr. Carlos 
Heinemann— 1879. Work inserted in the Gaceta Medica de Mexico, voL xv. 



124 appendijC to report on yellow-fever. 

Tlacotalpam is a city situated on the left bank of the same river, and at a dis- 
tance of twenty-five miles from Alvarado. It is also considered, by the physician 
I have mentioned, as a cradle of yellow-fever, whilst others^ are of the contrary 
opinion. 

Laguna is the principal town on the Island of Carmen, and derives its impor- 
tance from the exportation of dyewoods. This is another permanent centre of the 
disease, which causes numerous victims, every year, among the foreign sailors.' 

Campeche is the capital of the state of the same name, in the peninsula of Yu- 
catan, and is another source of yellow-fever at those times when federal troops are 
stationed there, proceeding from the more elevated parts of the country, or from 
abroad. This happened in the year 1865, when two companies of Austrian troops 
lost the greater part of their numbers through yellow-fever.* Dr. Patricio Trueba, 
a distinguished physician who has resided in Campeche for the last twenty-five 
years, is also of opinion that the crowding together of persons who have not gone 
through the disease, ^vors the development of yellow-fever. 

The city of Merida, capital of the state of Yucatan, which covers the northern 
part of the peninsula of Uie same name, as well as the districts comprised within 
that state under the name of Unucmd, Progreso, Temax, Tizimin, and Valladolid 
are considered as centres of yellow-fever by Dr. Jos^ Palomeque, a distinguished 
physician of Merida, and who declares that the disease in that place finds its 
greatest development amongst the foreigners who have not already had it, the 
natives of the elevated table-lands in the central part of the republic, and the In- 
dians from the other towns of the same state. Mr. Zayas Enriquez expresses the 
same opinion. < 

To the districts of the states of Yucatan which I have above mentioned. Dr. 
Domingo Orvafianos, in his recent work,' adds the districts of Motul and Maz- 
can6 as being centres of yellow-fever. 

The preceding lines will have demonstrated that in the Gulf of Mexico, and out 
of a length of 2,580 kilometres of coast, only that small part belonging to the 
canton of Veracruz, to the district of Frontera, to Campeche, and the northern 
coast of the peninsula of Yucatan, can be considered as centres of development 
for yellow-fever, as they are in constant communication, by sea, with each other, 
and with the island of Cuba. It is to be noted that these last mentioned localities 
are only separated from the island of Cuba by a narrow strait, and that it is nat- 
ural to suppose that the disease was originally imported from that island. 

In contrast to the narrow limits of the centres of infection, we can present the 
enormous coast line of the Gulf, and of the Pacific, where the germs of yellow- 
fever find a fertile soil for their development only when they are transported from 
those places in which the disease prevails in an endemic form. With the object 
of rendering my study of the subject more precise, and of basing it on exact data, 
I will now proceed to examine the different points on the Gulf and Pacific coasts 
from this point of view, taking the greater part of my data from the works which 
I have already mentioned. 

The port of Matamoros is situated opposite to Brownsville on the United States 

'Dn. Gregorio Mendizabel, and Diodoro Contreras. 
«Op. dt, page 247. 
•Op. dt. 

^Los Estados Unidos Mexicanos. — Mexico. — 1893. 

■Ensayo de Geografia Medica y Climatologica de la Republica Mexicana.— Dr. Domingo Orva- 
iianos.>-i889. 



APPENDIX TO REPORT ON YELLOW-FEVER, 125 

frontier, and has suffered from epidemics of yellow-fever in the years 1858, 1863, 
and 1867.1 

Altamira went through its first epidemic of black-vomit in the month of October^ 
1 82 1, shortiy after the arrival in that port of a vessel from Havana. More than 
fifteen hundred persons, both native and foreign, succumbed during the ravages of 
the epidemic. 

Tampico, situated on the left bank of the river Panuco, was visited, as I have 
previously mentioned, by its first epidemic of yellow-fever in the year 1843, 
twenty years after its foundation. ^ 

Tuxpan, on the left bank of the river of the same name, was visited by an epi- 
demic in the year 1838, which was not repeated until the year 1863, and was then 
imported by vessels arriving from Veracruz. It attacked the natives of the locality,, 
the Mexicans newly arrived from the table-land, and foreign sailors, and it after- 
wards spread to the villages of Jico and Huauchinango. 

Papantla and Misantla were visited by an epidemic of yellow-fever of the most 
deadly character, which was imported by the troops passing through those districts 
during the revolution of 1876. 

Naulta was visited by the epidemic in 1859, and 

Jicaltepec in the years 1861 and 1868. 

Trusting to the information given by Dr. Heinemann, in whose judgment I have 
the greatest confidence, I give a list of the following towns in which the yellow- 
fever has never appeared within the memory of man :* 

Santecomapan, La Barilla, Coatzacoalcos, Santa Anna, Cupilguillo, Dos Bocas, 
Chiltepec, San Pedro y San Pablo, Barra del Rio Palizeda, and Champoton. Ac- 
cording to many other numerous and reliable reports that I have received, the 
foreign sailors in these ports have hitherto escaped the disease, in spite of the hard 
work they have to perform under a burning sun, receiving and stowing the goods 
with which the ships are loaded. 

Although the above-mentioned author says that Coatzacoalcos and Minatitlan 
have not suffered from yellow-fever, they were nevertheless invaded by the epidemic 
in September of last year, the disease being communicated by persons who had 
arrived from Veracruz in the steamer May,^ 

Frontera has from time to time been visited by mild epidemics, which have at- 
tacked both natives and foreigners. 

San Juan Bautista de Tabasco had never been visited by yellow-fever until the 
year 1877, when it was imported by the troops under the command of General 
Enriquez, coming from Campeche, and touching in Frontera. 

The disease attacked the inhabitants o( this town, without distinction of race, 
and afterwards spread to Micaltepec, Huimanguillo, San Antonio, Cardenas, 
Nacayuca, Jalapa, Pichucalco. Doctor Castaiiares, who has lived in that locality, 
believes that the Mexicans who are natives of the cold country, and those of the 
neighboring state of Chiapas, are the first to be attacked by the epidemic, while 
it respects the natives of the state of Tabasco. 

I have already mentioned that the epidemic at times spreads from the ports to 
some of the towns situated within a certain distance of the coast. I now propose 
to treat, although lightiy, of the spread of the disease along the lines of railroads 
which run from Veracruz to Mexico, and Veracruz to Jalapa. 

During the construction of the first-mentioned line, and as the works advanced, 

^Heinemann. — Op. cit. 

sReport by Don Ignado Garfias, inspecting engineer of the National railway of Tehuantepec. 



126 APPENDIX TO REPORT ON YELLOW-FEVER, 

the disease presented itself in all the stations excepting that of Tejeria, although 
it is only situated at a distance of fifteen kilometres from Veracruz. This station 
preserves its immunity to this day, while in La Soledad, £1 Camaron, Paso del 
Macho, and Ato)rac a few cases of yellow-fever are observed almost every year. 

But the city situated on this road in which the epidemic has presented itself on 
several occasions, and where it has carried off the largest number of victims, is 
Cordoba. Situated at a distance of 105 kilometres from Veracruz, and at an 
altitude of 827 metres above the sea-level, it has undergone epidemics imported 
from that port, in the years i866-'67, i876-'77, i88o-'8i, and i892-'93.^ 

In the year 1876, more than two thousand persons perished in the epidemic, 
which spread to many of the neighboring towns and villages. 

Following the ways of communication by the road from Veracruz to Jalapa, the 
epidemic was carried to the towns of San Juan, and Paso de Ovejas, but never 
reached Jalapa, which is almost at the same distance from Veracruz as Cordoba, 
but at an elevation of 1,320 metres above the sea-level. 

The highest point in which the yellow-fever has, up to the present date, been 
found susceptible of development, is the village of Las Animas, situated between 
Cordoba and Orizba, at an elevation of 1,008 metres above the sea-level. 

The extensive coast of the Pacific had always enjoyed an immunity from this 
epidemic, with the exception of short stretches belonging to the states of Michoa- 
can, Oaxaca, and Chiapas, which on two distinct occasions had been visited by 
yellow-fever. 

In the localities which I am about to mention, all memory had disappeared of an 
epidemic of this class, if they ever had known such a thing, so that when it pre- 
sented itself in Mazatlan, the local physicians did not recognize it, believing that 
it was not a disease special to that climate. Nevertheless, in August, 1883, the 
Pacific mail steamer, San yuan, arrived with sick people on board, who imported 
the yellow-fever in Mazatlan. The epidemic spread with such rapidity that within 
five days three thousand persons were attacked with the disease. From Mazatlan 
it extended to Guaymas, San Bias, Acapulco, Manzanille, and other places. 
Among these latter, I would especially mention Culiacan, and Hermosillo, on ac- 
count of the distance at which they are situated from the coast. The epidemic 
ceased in the month of October, in the same year, and has never been repeated. 

From the preceding remarks, it will be seen that the immense coast of the re- 
public washed by the two oceans, is always liable to be invaded by epidemics of 
yellow-fever when it is imported. 

Matamoros was visited by epidemics in the years 1858, 1863, and 1867. 

As we have already seen, the epidemic appeared in Altamira during the year 
1 82 1, after the arrival of a vessel from Havana. 

The first epidemic was carried to Tampico in the year 1843, ^y troops from 
Veracruz. 

To the same circumstance we attribute the great ravages committed among the 
American troops in 1847-^48, who garrisoned that town during the war. 

The epidemic was also imported into Tampico during the years 1863-64, by two 
battalions of the French army. The great epidemic that ravaged Tampico in Sep- 
tember, 1878, was imported from New Orleans with a cargo of grain, and acquired 
its development because it fell on favorable ground, the cyclone which had previ- 
ously devastated the coast having caused great inundations in the neighborhood of 
the port. 

^Data furnished by Dr. Gregorio Mendizabel, of Orizaba. 



APPENDIX TO REPORT ON YELLOIV-FEVER. 1 27 

In June of the following year, a large shipment of damaged cotton goods was 
received in this port, which had been submerged in the sea. These goods were 
hung up to dry in the rooms occupied by some employes of one of the stores, and 
this circumstance gave rise to the commencement of an epidemic which lasted until 
the month of December. 

I must here state, that from that date no new epidemic has appeared in Tarn- 
pico, although isolated cases have been observed in persons who carried the dis- 
ease with them from Veracruz. 

Tuxpan was visited by an epidemic in the year 1838.^ Dr. Ordozgoiti does not 
state how the epidemic developed itself, but he clearly declares that the epidemic 
of 1863 was imported from ships arriving from Veracruz. As I have always said, 
the muleteers carried the disease as far as Jico and Huauchinango. Troops arriv- 
ing at Tuxpan from Veracruz introduced the epidemic in the years 1877 and 
1878. 

Papantla : A detachment of troops passing through this town in the year 1876, 
brought an epidemic of yellow-fever with them which developed the most deadly 
characteristics. 

Nautla : An epidemic took place here in the year 1859. 

Jical tepee: An epidemic appeared in this town in the year 1861, which was 
limited to the right bank of the river Nautla.^ It was also visited by an epidemic 
in the year 1868. 

Coatzacoalcos : The yellow-fever was carried to this port in the month of Sep- 
tember, 1892, by some sick men on board of the steamer May, from Veracruz. 

Minatitlan : The disease was carried to this port at the same time and under the 
same circumstances as the one last mentioned. 

Frontera : From time to time mild epidemics are observed in this town, the dis- 
ease affecting both foreigners and natives alike. ^ 

San Juan Bautista : As I have already stated, this port is situated a long distance 
from the coast, and on the right bank of the river Grijalva. An epidemic raged 
there in the year 1877, having been imported by Mexican troops which had touched 
at Frontera on their way from Campeche. From San Juan Bautista the epidemic 
spread to Micaltepec, Huimanguillo, San Antonio, Cardenas, Nacayuca, Jalapa, 
and Pichucalco. 

Don Francisco Arguelles,* who is quoted by Dr. Heinemann, says that the first 
cases of yellow-fever which appeared in Pichucalco, originated in the house of a 
Spaniard named Bustamente, who had just received a shipment of goods from San 
Juan Bautista : *« These goods were transported up the river, in canoes, to a point 
distant one league from Pichucalco, where they were unloaded, and carried to the 
town by mules. Mr. Arguelles knows nothing of the fate of the canoe-men, but he 
asserts, that all the muleteers took the disease. A few days after the arrival of the 
goods, all the people living in Mr. Bustamente^s house fell sick, and fourteen of 
them died. From this house the contagion was propagated throughout the whole 
town, making numerous victims, in all classes, among the residents ; but it was 
remarked that the Indians who came from the cold country [San Cristobal, Chi- 
apas] succumbed to the disease with greater facility than those from the hot 
country. After a few days, the merchandise forming this unfortunate shipment was 
carried on the backs of Indians to San Cristobal, but on the road itself the porters 

^Heinemaim.— -Op. cit. 

*Mr. Barnard, dted by Dr. Heinemann. 

*Heinemann. —Op. cit 



128 APPENDIX TO REPORT ON YELLOW-FEVER. 

were attacked by the disease, one after the other. The epidemic did not reach San 
Cristobal, which is five leagues^ journey from Pichucalco, and its force was greatly 
diminished by the month of August, although it still continued on a smaller scale 
till the .beginning of December, when it finally disappeared.*" 

Dr. Castafiares, who has practised his profession for twenty-three years in 
Tabasco, says that the epidemics only appear in that state when there occurs a great 
crowding of people under unhealthy conditions, as for instance, in a military en- 
campment. Dr. Castaiiares believes that the epidemic attacks with greater 6icility 
the natives of the neighboring state of Chiapas. According to Dr. OrvaBanos,* epi- 
demics of yellow-fever have visited the state of Yucatan in the years 1855, 1857, 
1881-82, and 1883, and have also appeared in the state of Veracruz in the years 
1863, 1872, 1873, 1875, 1878, and i879,and inCampecheintheyear 1865. The 
author does not give any details as to the manner in which the epidemics developed 
themselves. 

Dr. Orvaiianos speaks of epidemics having appeared in the state of Michoacan, 
during the years 18 13, 18 14, and i860, but I believe that this can only havetakea 
place along a short stretch of coast, as I can find no record of these epidemics. 
The same remark applies to the state of Oaxaca during the years 18*50 and 1857. 
In the work of this author to which I refer, he simply says, as I have above shown, 
that in the states of Jalisco and Sinaloa an epidemic appeared in the year 1882, 
but this assertion is plainly contradicted by Dr. Praslow,' who says as follows : 
*• The yellow- fever was imported by the American steamers, as I will prove further 
on, for this disease was never previously seen on the coast of Sinaloa and Sonora, 
a fact that can be clearly proved by the books which from the time of the Jesuits, 
have been written, and which speak of other diseases, but not of the yellow-fever."" 

The epidemic which spread during the year 1883 along the entire coast of the 
Pacific, is of the greatest interest, in view of the question we are now studying. If 
any previous epidemics had ever appeared, the memory of them was so completely 
lost, that when the first cases of yellow-fever presented themselves in the port of 
Mazatlan, the physicians did not recognize them, founding their doubts on the £aict 
that this disease had never been seen on the west coast of Mexico. Another great 
point of interest presented by this special epidemic, is found by following up the 
way in which the disease was introduced, that is to say, by sea. Dr. Praslow* main- 
tains that the yellow-fever may have been imported, from the year 1882, by the 
steamers of the Pacific mail, which brought yellow-fever patients firom Panama, 
who did not land. He proves this assertion by letters from persons who had trav- 
elled in the steamer CoUfna^ on board of which the captain and six stewards fell 
sick. 

The same did not happen in August, 1883. In that month the steamer ^^^t 
ytian^ belonging to the same company, reached Mazatlan with thirty- three sick 
people on board, coming from Panama. Some of them landed, and the conse- 
quent epidemic spread with such force that, as I have before said, more than three 
thousand people were attacked in the port within the first five days, while twenty- 
two died in only one day. The epidemic rapidly extended itself to other ports on 
that coast, and visited the ports of La Paz, Guaymas, Altata, San Bias, Manza- 
nillo, Santiago Acaponeta, Acapulco, Puerto Angel, Salina Cruz, Tonala, Soco- 

iHdnemann.— Op. cit. 

>Apttntes sobre la fiebre amarilla en la epidemia que rdno en Culiacin en Agosto de 1884. — Culi « 
acin.~i884. 
■Op. dt. 



APPENDIX TO REPORT ON YELLOW-FEVER. 1 29 

nQSCo, Tapachula, and San Benito, and in the interior at Hermosillo, and Culi- 
adin.^ A very important iaxX to be borne in mind is, that in all the territory 
included between the Yaqui and Mayo rivers, which is inhabited by Yaqui Indians 
under command of the valiant chief Cajame, the epidemic did not put in an ap- 
pearance. This was due to the energetic attitude assumed by the chief of the 
tribe, who prohibited all communication with the outside world, either by sea or 
land, under penalty of death. This &ct has the force of an experimental demon- 
stration, and clearly shows the sovereign efficacy of isolation as a precaution against 
the transmissible infectious diseases. 

IMMUNITY. 

It is a universally accepted feet, that an individual who has once suffered an attack 
of yellow-fever is exempt from any more ; but exceptions can be found to this rule, 
the same as in the cases of typhus, typhoid, and even scarlatina ; but these cases 
are comparatively rare, and they are so with yellow-fever. This immunity is ac- 
quired after severe attacks as well as mild ones, and even when the attacks have 
been abortive. 

Other persons who also enjoy immunity from the disease, are those who have 
been bom in those places where yellow-fever is endemic. This immunity is so gen- 
eral, that Dr. Heinemann has made use of it to establish the difference between 
the r^ons where the disease is endemic, and which are in this paper considered as 
centres, and all those other places which present fsivorable conditions to the devel- 
opment of the disease when imported^ but in which it does not spontaneously 
engender. Nevertheless, this immunity is not by any means absolute, as the physi- 
cian whom I have quoted mentions cases of persons who had been bom and had 
lived in Veracruz, and who nevertheless had been attacked by yellow-fever. Sim- 
ilar observations have been made by other physicians of Veracruz, who are worthy 
of all credit. 

The immunity can, in some cases, although very rarely, be lost ; when the per- 
son who had enjoyed it, had been absent for a longer or shorter period from the 
locality. The time required to elapse before this immunity is lost, is variable.' Dr. 
Garmendia relates the case of a relation of his own, who was bom in Veracruz,, 
and lived there. He remained in Europe for three years, and on his retum suf- 
fered an attack of yellow-fever that put his life in danger. A gentleman of advanced 
age, who for many years had £lled the position of director of the military hospital, 
was attacked by yellow-fever after having passed some years in Jalapa, and in the 
capital of the republic. 

As I have before stated. Dr. Heinemann considers, that the immunUy of the 
natives in any locality where the yellow-fever reigns in an endemic form, is the cri-- 
terion to guide us in classifying the indemia, 

«* In a town in which yellow-fever had been prevalent for many years,^ he says, 
** the natives of the place acquire an immunity ; but if for another series of years 
the disease should not appear, the natives will lose the immunity that they had 
acquired." A proof of this is found in what happened in Tampico : epidemics 
appeared in 1843, 1^47* i^4^> ^<^ i^53* ^P ^ ^^ ^^^ ^^ epidemics attacked 
both foreigners and natives of the locality, but in the epidemics of 1863 and 1864 
the natives had acquired that immunity, and therefore escaped. But after the year 

iDocuments of the Supreme Board of Health, of Medco. 
'Dr. Garmendia, quoted by Dr. Heinemami. 



130 APPENDIX TO REPORT ON YELLOW-FEVER. 

1878 they had lost this immunity, as is proved by the fa^ that Dr. Hegevich» 
physician of the military hospital in Veracruz, attended several soldiers who were 
natives of Tampico, and who contracted the disease in that port, besides the son 
of a merchant in Tampico who had removed his business house to Veracruz. 

I venture to give an explanation of this fsict, which appears so extraordinary to 
Dr. Heinemann, whose opinions I have so largely quoted in the preceding para- 
graph. 

Starting from the unquestionable fsict, that an individual who once undetgoes an 
attack of yellow-fever is afterwards safe from this disease ; that this immunity is 
enjoyed both by those who have suffered from severe attacks as well as by those 
who have only had slight attacks, and even by those persons in whom the disease 
had presented itself in an abortive form, taking for granted the bxX that in those 
localities in which the disease had prevailed for many years, the natives acquire 
that immunity in the course of time, which they afterwards lose if the disease has 
not appeared for another series of years, we can base the hypothesis, that all those 
persons who enjoy such immunity, have acquired it by previous attacks, which have 
generally been of a mUd character, sometimes abortive, or perhaps in the earliest 
in£uicy. This hypothesb is supported by the practice of many ladies who, finding 
themselves absent from the localities in which yellow-fever reigns in an epidemic 
form, returned to those localities previous to their confinements, with the object of 
placing their children in a position to acquire that immunity. The idea that I am 
now presenting is not only my own, but b also largely supported by many physi- 
cians of Veracruz. 

The conviction that mild attacks of diseases which can only be taken once in a 
life-time form a safe-guard against any graver form of the same disease, is what 
induced physicians to inoculate persons with a mild form of small-pox, as a pre- 
caution against the real and dangerous disease, until the admirable discovery of 
Jenner demonstrated the possibility of rendering men safe against thsU terrible 
scourge. In later years we have seen the wonderful discoveries of Pasteur, and 
following his footsteps, we have earnest workers from all nations, laboring night 
and day in patient investigations and scientific experiments, all directed to procur- 
ing the immunity of men and animals against certain diseases. This brings me 
to speak on the question of preventative inoculations. 

Neither I nor any of my colleagues from the Mexican republic have any expe- 
rience with regard to the practising results of the inoculations made by Dr. Freire, 
of Brazil, and therefore, I shall confine myself to speaking of those which have 
been practised by Dr. Carmona y Valle, of Mexico. This friend and colleague of 
mine published in the year 1885 his Qinical Lectures on the etiology and prophy- 
laxis of yellow-fever, and with the object of procuring the immunity of those per- 
sons who might be disposed to contract the disease, he proposed to inoculate them 
under the sldn with a mixture of one gramme of distilled water to one or two cen- 
tigrams of residue of the urine from yellow-fever patients, which had been sub- 
mitted to spontaneous evaporation, so as to obtain a dry deposit. After numerous 
experiments on animals, Dr. Carmona inoculated himself, as well as other persons 
who voluntarily presented themselves to help him in his experiments. The results 
having convinced him of the innocuousness of the method, he inoculated persons 
who were going from Mexico to Veracruz, Havana, or the Pacific coast, which at 
that time was being ravaged by yellow-fever. The greater part of the persons 
escaped the disease, but a few were attacked, and some even died. The experi- 
ments were, therefore, not of a decisive character. In order to give it this char- 



APPENDIX TO REPORT ON YELLOW-FEVER, 131 

acter, it was proposed to make comparisons of the mortality caused by yellow-fever 
among the convicts living in the penitentiary of San Juan de Ulua, on an island 
in the port of Vera Cruz, in front of the city, and the soldiers, who should be pre- 
viously inoculated by this system, from the garrison of Veracruz. Both these 
classes of men are taken to Veracruz from the more elevated parts of the republic ; 
they are not acclimated, and mostly belong to the same social status. 

The number of sick people admitted into the dvil and military hospitals of Vera- 
cruz during the months of January to May, 1885, as well as the comparative table 
of the sick who came from the penitentiary, and the soldiers of the garrison, wko 
had been prevumsly inoculated^ are set forth in the works of Dr. Carmona.^ A 
study of this work shows us "that during the five months of the year in which the 
epidemic raged, the number of convicts who were attacked niunbered seventy-two, 
being 41.62 percent., while the number of cases among the inoculated soldiers 
only came to twenty-six, or otherwise, 6.84 per cent." 

It might be objected that the conditions of life, and the moral condition of the 
persons submitted to the experiment, were not similar, but Dr. Carmona also pre- 
sents the testimony of one hundred and seventy-four soldiers who arrived at Vera- 
cruz at the end of July of that same year, and who had not been inoculated or 
acclimated. These soldiers came from the state of Tabasco, where they had been 
living in a climate as hot as that of Veracruz. This group could very fairly be 
compared with that which was formed by the garrison of the place, the soldiers of 
which had been inoculated. 

The following were the results : In three months there were fifry-six cases in the 
first group or 32.18 per cent, (it must be remembered that in tiie group of con- 
victs the percentage was 41.62), which makes us believe that if the observation had 
lasted as long as the other, i. e., five months, the percentage would have reached 
the 41 .62. 

From these &cts we can infer that inoculation, and not the hygienic conditions, 
was what caused the least proportion of cases. 

Notwithstanding that these fsicts have been known, no experiments have been 
made, either in the republic or abroad ; but I believe that it b now time to again 
experiment, in order to find out their true value. 

Had we not been convinced of this, we would have become so by reading what 
the eminent Dr. George M. Sternberg* says in his review. 

He says : "According to the results to which we refer, the writer has thought 
that inoculations, as practised some years ago by Dr. Carmona y Valle, of the city 
of Mexico, may have had rational bases." 

He adds: "Lacking the knowledge of the infectious specific agent of yellow- 
fever, two methods are presented which may obtain immunity by inoculation. 

"The first method is to follow the experiments of Professor Carmona, by which 
a quantity of specific tox-albumen of yellow-fever is introduced, in the supposition 
that such substance exists in the blood of patients during the progress of the 
disease. 

" The second method is, to introduce in the circulation of the susceptible per- 
son the anti-toxin of the yellow-fever which, if we reason by analogy, is to be found 
in the blood of persons who enjoy immunity. 

^Lecons sar P Etiologie et la Prophilaxie de la Fievre Jaune, Mexico, 1885. De qudques faits rel- 
atifs \ la Fievre Jaune, Rapport presente parle Dr. Carmona 7 Valle. 

'Inoculation for contagious diseases. Prelizninarj report of the committee of the American Asso- 
ciation of Public Health. 



132 APPENDIX TO REPORT ON YELLOW-FEVER. 

« In the experiments made to determine the possibility of establishing immunity by 
the first method, we should propose that the urine shall be evaporated rapidly in 
vacuum." 

As it will be seen, Dr. Sternberg recommends the inoculations of Dr. Carmona, 
accepting the hypothesis that the urine of yellow-fever patients may contain spe- 
cific tox-albumen which might produce immunity. 

This hypothesis is strengthened by the demonstrations of Dr. Bouchard, of 
France, which show that what is so inoculated is eliminated through the urine. 

As I have demonstrated that the only way to have immunity is by having had 
the yellow-fever, if we succeed (with Dr. Carmona^s inoculation) in introducing a 
substance which shall produce immunity, then we shall have obtained the same 
results as vacdne in small-pox. 

With the idea of scientific principles which modern science has reached, the 
inoculations of Dr. Carmona should be tried again, making the rapid evap- 
oration of the urine in vacuum, as recommended by Dr. Sternberg, and as experience 
has demonstrated that they are harmless, and easy in their technic, they should be 
made simultaneously in all countries where yellow-fever exists, or is liable to be 
introduced. 

Were results to be published in a uniform manner, in blanks printed for the pur- 
pose, by the yellow-fever committee, then we would soon find out whether the 
inoculations have any value or not. 

If results justify the practice, we shall have obtained immunity for the people 
who are compelled to live in those places, and if not, the second method should 
be tried, i. e., the one proposed by I>. Sternberg ; the inoculation of blood secured 
jfrom persons already immuned. 

As prophylactic means, I reconmiend the purification of drinking-water, for Dr. 
Gavifio, professor of bacteriology in the Medical school of Mexico, has observed 
that in Veracruz the people who drank well or dstem water, or others kept in 
such a way as to become impure, were more liable to the disease than those who 
drank the water of the Tampa river when it had not been contaminated. 

The same professor, on examining the drinking-water of Veracruz, found an 
unknown bacteria, which liquefies gelatin, and congregates in oval colonies, of a 
yellow-greenish color, which reminds us of the color of yellow-fever patients. 

He examined the liquid firom the intestines, and found a bacillus of the same 
character, but shorter than the one found in the water. 

This similarity, and the fiurt that bacteria was not found in the liver, spleen, kid- 
neys, or blood, made him believe that yellow-fever is an intestinal disease. 

Were this to be confirmed, the purification of water is an absolute necessity, but 
if it is not confirmed, it will be of benefit to those who drink it. 

The last subject which I propose to study, b the means by which we can prevent 
the importation of yellow-fever. 

This is a most important point when we consider that if the methods of which 
we have spoken will some day prevent the disease, the measures which we are going 
to propose, strictly enforced, will not only prevent the disease fi-om spreading out 
of the present epidemic centres, which are few, into the great territory of our re- 
public, which although it does not originate the disease, is very fertile to receive it, 
but what is still better, the measures proposed will prevent the disease finom being 
imported to our centres in seasons when there is no fever. 

This should not be called an ideal, because it is a known feet that many doctors 



APPENDIX TO REPORT ON YELLOW-FEVER, I33 

and historians believe that yellow-fever was imported to Veracruz, our principal 
centre, more than three centuries ago. 

What happened in New Orleans is the best proof of the assertion, for that port 
was a centre of infection, from whence it was taken to Tampico, as we have already 
said, and the fever has not shown itself for the last fourteen years, since that port 
has been closed to vessels from infected ports. 

The measures which I proposed are founded on the two great resources placed 
within our reach by hygiene, — isolation and disinfection^ applied not only to vessels 
coming to infected ports, but to those leaving the said ports. 

Having reduced to a minimum the harm which all sanitary measures generally 
bring to commercial interests and communications, we have not forgotten that 
solus populi suprema lex est. 

The measures are as follows : Landing and isolation of the sick ; keeping pas- 
sengers who may be suspected, and who land, under observation for seven days, 
and allowing those who will not submit to observation to proceed to places over 
1,000 metres above sea-level. 

Disinfection of the ship, or the parts which may have become infected. 

Disinfection of ship^s manger, and fresh water supplied. 

Disinfection of all wearing-apparel, baggage, and merchandise liable to infection, 
especially packing-cases. 

These measures not to be so strictly enforced if the ship has no sick on board 
on arrival, if it has no merchandise liable to infection, or if it has on board a dis- 
infecting apparatus, and a doctor. 

Accompanying this paper will be found the articles referring to yellow-fever, of 
the maritime police ordinance, as approved by the board of health, and now under 
consideration by the house of representatives. 

This small paper, which I have the honor to submit to the international com- 
mittee of yellow-fever, can be summed thus, — 

First. The places where yellow-fever reigns, and which can be considered as 
centres of infection, are in the Gulf of Mexico, — ^Veracruz, Frontera, Campeche, 
and the districts on the northern coast of the Yucatan peninsula, the last named 
separated by the Yucatan canal from the island of Cuba, where the fever also 
reigns. 

On the accompanying map, the centres from which the disease originates are 
marked in orange color. 

On the great Pacific coast, which belongs to the Mexican republic, there is not a 
single yellow-fever centre. 

Second. All the Mexican territory on the Gulf of Mexico, and on the Pacific 
coast, is well adapted for the disease when imported. 

Third. Yellow-fever has become epidemic in the following places on the coast of 
the gulf: Matamoras, Altamira, Tampico, Tuxpan, Papantla, Misantla, Nautla, 
Alvarado, Coatzacoalcos, Minatitlan, Lagang, and San Juan Bautista de Tabasco. 

Fourth. The epidemic has extended into the interior, but never into places sit- 
uated more than 1,008 metres over sea-level. 

Fifth. On the Pacific there is not a yellow-fever centre, but it has been imported 
into the following places : On the peninsula of Lower California, La Paz y Todos 
Santos ; on the continent, Guaymas, Altata, San Bias, Manzanillo, Santiago, Aca- 
poneta, Acapulco, Puerto Angel, Salena Cruz, Tonala, Soconuzco, Tapachula, and 
San Benito, and in the interior in Hermosillo y Culiacan. 

On the accompanying map will be found, marked with a light yellow, the places 



134 APPENDIX TO REPORT ON YELLOW-FEVER, 

where an epidemic has taken place, but in which the fever does not rdgn in an 
endemic form. 

Sixth. Immunity against yellow-fever is obtained after having had the disease in 
any of its forms. 

It is possible that this immunity may be lost at times, but it is seldom the case, 
as it happens with typhus, small-pox, and scarlet-fever, which may be had by a 
person who has had them. 

Seventh. The vaccine of Jenner against small-pox, and others which science has 
discovered, authorize us to look for the one that will prevent yellow-fever. 

The inoculation against this fever which Dr. Carmona y Valle has practised with 
success, should be tried on a large scale, in a uniform manner, in order to be able 
to find out if it is efficacious or not. If this experience confirms it, then it 
should be made compulsory in the countries where the fever reigns. 

If it should not prove worthy, then the inoculation of blood serum, as pro- 
posed by Dr. Sternberg, fix>m persons enjoying immunity, should be tried on a large 
scale and in a uniform manner. 

Eighth. The purification of the drinking-waters used by persons who have to 
expose themselves to contact with the disease, should be recommended. 

The purification of the water used on board the ships leaving or calling at in- 
fected ports, should be proposed. 

Nintii. The sanitation of the places which are yellow-fever centres should be 
done at once. 

Tenth. To prevent, by means of sanitary police measures, the importation of 
fever into places where it can be developed. 

Measures to be adopted by Mexico will be found accompanying this paper. 

Dr. £. Lio^AGA. 



ARTICLES FROM THE MARITIME SANITARY POLICE ORDINANCE. 

Article 20. 

If fi-om the report mentioned in articles 1 1 and 12, it should be seen that a ship 
is infected with yellow-fever, that is, if it arrives with sickness on board, or has 
had it the preceding seven da3rSf and the port b one of those in which the disease 
is not endemic, the following rules must be observed : 

A. Patients shall be immediately taken to the federal lazaretto, if there is one. 

B. Ships shall be disinfected; if not all, the part which may be considered 
as infected. 

C. Wearing-apparel of passengers, and all merchandise liable to infection, shall 
be disinfected. 

D. These measures having been taken, the landing of passengers shall be al- 
lowed, but they must be taken to a place more than 1,000 metres above sea-level, 
where they shall remain seven days under the observation of the local authorities, 
who shall be advised of the arrival of the passengers by the delegate of the board 
of health. 

E. The manger of the ship shall be disinfected, and the water changed. 



APPENDIX TO REPORT ON YELLOW-FEVER. 135 

Article 21. 

If the ship only stops in port, and arrives in the condition expressed in the pre- 
ceding article, the following shall be done : 

A. Sick passengers booked for that port shall be taken to the lazaretto. 

B. Measures shall be taken to isolate other sick passengers in the same ship. 

C. Places which shall have been occupied by sick passengers shall be disin- 
fected. 

D. Wearing-apparel of the passengers who have landed, shall be disinfected ; 
also merchandise liable to infection. 

£. Measures indicated in fractions C and £ of the preceding article, shall be 
taken. 

Article 22. 

Should an infected ship arrive at a port in which there is no lazaretto, it shall 
remain isolated in quarantine until five days after the appearance of new cases, and 
then all measures indicated in the preceding articles shall be taken, or the ship al- 
lowed to return to the port from whence it came, or to proceed to a port in which 
there shall be a lazaretto, and isolation possible. 

Article 23. 

If by the report received by the delegate of the board of health, the ship is a 
suspected one, that b, that a case or cases of yellow-fever have appeared on leaving 
port or during the voyage, but no new cases have developed in the preceding seven 
days of navigation, the following shall be observed : 

A. A doctor^s visit, to find out the true state of the passengers and crew. 

B. Disinfection of the wearing-apparel of the crew and passengers which shall 
be considered as infected ; also the merchandise liable to infection. 

C. Passengers landed shall be under the observation of the local authorities for 
^vt days, and for this purpose, the delegate of the board of health in charge shall 
advise the authorities of the arrival of the passengers, who must present themselves 
to the said authorities to be allowed to proceed to places over 1,000 metres above 
sea-level. 

D. Vessel^s crew shall not be allowed to land, except on business connected with 
the service. 

£. After the above measures shall have been taken, the ship's manger shall be 
disinfected, and supplied with fresh water. 

Article 24. 

If the suspected ship is only stopping on its way, the sanitary measures to be 
taken shall be those prescribed in fractions A, B, and C of the preceding article, 
applied to passengers and merchandise that shall be landed. 

Article 25. 

If the ship is indetnne^ that is, that when coming from an infected port it has no 
sickness on board or has had none, and the time from its leaving port is more than 
seven days, the following regulations shall be observed : 

A. Sanitary inspection. 

B. All soiled linen, and all other wearing-apparel, shall be disinfected ; also 
merchandise liable to infection. 



136 APPENDIX TO REPORT ON YELLOW-FEVER. 

C. Ship^s manger shall be disinfected, and supplied with fresh water. 

D. It shall be optional with the delegate of the board of health to keep passen- 
gers under surveillance. 

£. Vessel^s crew shall not be allowed to land, except on business connected with 
the service. 

Article 26. 

If the ship is indemne, has a doctor on board, and a disinfecting apparatus, and 
if wearing-apparel and merchandise have been disinfected, it shall be released. 

Article 27. 

If the ship has called at an infected port, or has had communication at sea with 
an infected ship, or has transferred sick persons, or merchandise liable to infection, 
it shall be considered as an infected or suspected ship, and held subject to regula- 
tion for either case. 

Article 28. 

In case that the merchandise, baggage, and wearing-apparel on board of a ship 
are protected by a certificate of disinfection, procured at place of shipment, or on 
board (if ship has disinfecting apparatus, and a doctor to direct its operations), 
then, the objects which the delegate of the board of health may consider contam- 
inated, shall be disinfected. 

Article 29. 

Authorities representing the health department in fourth-class ports, shall only 
allow the landing of merchandise and passengers of an indemw ship, when pro- 
tected by certificate of disinfection made at another port. Infected ships shall not 
be allowed to enter, and be compelled to go to the nearest first, second, or third- 
class port. 

Article 30. 

The executive of the nation, when advised by the board of health, shall, by 
proclamation, declare the ports where fever is endemic, or has ceased to be so. 

Article 31. 

Ships sailing from infected ports to ports where yellow-fever is endemic, shall be 
released, except in case that the disease has ceased to exist for five days previous 
to arrival at said ports, in which case they shall be subjected to regulations pre- 
scribed in the preceding articles. 



XXVIL 

EXPLANATION OF THE SCIENTIFIC PRINCIPLES, AND OF 
THE DATA ACQUIRED THROUGH EXPERIENCE, ON 
WHICH THE ORDINANCES OF THE INTER- 
NATIONAL MARITIME POLICE WERE 
FOUNDED. 

By Dr. EDUARDO LICfiAGA, 
Mexico, 

Before speaking of the way in which the sanitary service has been 
organized and how it has been regulated and the manner in which the 
vessels are received, I desire to say a few words concerning the principles 
which have served us as a basis in the formation of the Maritime Health 
Ordinances. 

The resources at the disposal of the hygienists for preventing the 
invasion and propagation of the infectious diseases, are isolation and 
disinfection. Isolation of the sick, in special hospitals, is being daily 
perfected, and consequently it is growing more efficacious. Quarantine, 
another means of isolating the contaminated vessels and passengers which 
might contain germs of the disease, is also being perfected ; but in this 
case the progress obtained consists in the diminution of the days at 
quarantine. The object of disinfection is to destroy utterly the germs of 
transmissible diseases. When the microorganism, which engenders every 
one of the infectious diseases, and the physical or chemical agents which 
more surely destroy them, are known, disinfection will reach to a still 
higher levd of perfection than it is at present. 

Clinic and bacteriology have been vital factors in the progress of the 
knowledge of Asiatic cholera ; the microbe which it originates is known ; 
also where and how it is developed, how long it takes to bring on the 
disease, and it is known that they are contained in the dejectures of the 
sick ; that they are preserved in the soiled clothes or in articles which 
have come in contact with them ; that they are propagated in greater pro- 
portions in water than in anjrthing else; that they are not transmitted 
in new goods; that the bichloride of mercury destroys them, and also 
vapor imder pressure, etc., etc.; and from this knowledge the principles 
have been brought to light which have served us to establish a quarantine 
system, as well as the fact that cholera may never enter a port. 

Last season's epidemic, brought on by some European trading vessels, 
has taught us much on this subject and has demonstrated the inadequacy 
of certain practices which had been preserved only by custom. 



138 THE MARITIME HEALTH ORDINANCES. 

It is evident that it is of the greatest importance to know if the port 
from which the vessel sailed is invaded by the epidemic ; if it took sick 
passengers on board ; if it has contaminated water or is suspected of being 
infected ; if the vessel has good hygienic conditions ; all of which may be 
ascertained by t?ie bill which it brings. It is, maybe, more important to 
know in what state the vessel has arrived ; if it has any sick passengers or 
has had them during the last days of the voyage. In the latter case, if this 
is found to be so, the vessel is declared as infected; if it has had cases of ill- 
ness, but after seven days have elapsed since the vessel left the infected 
port, in this case the vessel is declared as suspected; and lastly, if it comes 
from a port suffering from this disease, but does not have any cases on 
board, or has not communicated with any vessel that has had them, in this 
case it is declared as indemne. 

As the reports relative to seaports are given by the local authorities, 
and experience, notably that of last year, has taught us that a clean bill 
can be issued at infected ports or those whose surroundings are infected, 
it is expedient that consuls should advise by the ordinary means, or by tele- 
graph, the true condition of the sailing port, with the changes xmdergone 
after the issue of the bill. 

In order to verify the report of the captain or of the master of the 
vessel, concerning the cargo or relative to the health of the passengers 
and of the crew, a rigorous inspection will be maintained at the ports by 
the delegates of the board of health. From their visits, from the reports 
of the officers on board, — ^which must be, however, duly certified — ^from the 
personal inspection of the crew, from the information gathered from the 
passengers ; in fine, from all these data obtained they are free to declare 
whether the vessel is infected, suspected, or indemne. 

These regulations, adopted by the convention held at Venice in 
January, 1892, were accepted in Mexico by our circular of the ist of 
September, 1892, respecting quarantine measures ; but the epidemic 
rage in Europe that same year has served us more than any other thing 
to prove the uselessness of certain measures, and their positive and 
detrimental injury to commerce and to all other intercourses of maui 
and brought JEorth the project of assembling an international con- 
ference of the best known hygienists and diplomats versed in these 
matters, to study anew this question. The conference was held, and 
reasons were given there analagous to those which I had the honor to 
communicate last year to this assembly, in regard to diminishing the days 
at quarantine. A similar hope was expressed that this hindrance to com- 
merce should be entirely removed, as has been done in England, but in 
the other countries this will not occur till disinfection has reached a higher 
point of perfection, when isolation of the sick shall be more thorough, and 
when all the necessary precautions have been taken to improve the 
sanitation of the cities. 

This conference, accepting the advantages realized by that held at 
Venice, has introduced many others, which facilitate the free passage of 



THE MARITIME HEALTH ORDINANCES, 1 39 

travellers, the unloading of the cargo, etc., etc.; and this has been obtained 
without diminishing the interests of the public health, by such means and 
measures as are justifiable by the present science, and which have been 
free from the advice given by those persons who become panic-stricken 
whenever cholera invades their country. 

With the adopted resolutions of the conference, an international con- 
vention was signed at Dresden, the 15 th day of April, 1893, by eighteen 
of the nations represented there, and accepted <id referendum by the 
others. 

We have endeavored to adjust the resolutions of that conference to the 
precepts of our Ordinances, as it not only realizes the ideal which we 
had aimed at on this subject, but because we put ourselves in accord with 
quarantine ordinances of the European nations with whom we maintain 
commercial relations, and because by so doing we get the other ideal 
described by us, namely, the uniformity in all countries of the police 
sanitary ordinances. 

Having given these details, we can now give an idea of our Ordinances. 

The reports have the form of certificates, and comprise all the informa- 
tion concerning the passengers, crew, the state of the vessel, etc. (Arts. 
1 1 and 1 2 of the Ordinances.) 

If from this information it results that the vessel brings no sick cases, 
nor has had them, nor comes from an infected port, nor the vessel or 
the cargo is infected, the vessel is granted free entry. (Art. 36 of the 
Ordinances.) If the vessel is infected, that is to say, has sick on board, 
or has had them during the last seven days, the latter will be taken to the 
lazaretto, where they will be absolutely isolated. The passengers in good 
health will be kept under surveillance on board the vessel as long a 
period as five days, and in the meantime the soiled linen and the cargo 
which is to be brought to land, and which may be thought likely to be 
susceptible to impart the disease, as well as the vessel or that part which 
has been contaminated, will be disinfected, and the water of the manger 
will be changed. (Art. 13 of the Ordinances.) 

But if the vessel has on board a disinfecting stove, and a physician 
directing the operation, of whose efficiency the delegate of the board of 
health is sure, the disinfection will not be repeated at the incoming of the 
vessel to port. 

If the vessel is suspected^ that is to say, if it does not arrive with any 
sick cases, nor has had them during the last seven days, but had them 
previous to that time, or at the leaving from the sailing port, the visit of 
inspection will be made, the soiled linen will be disinfected, as well as the 
vessel, or that part which needs it ; the water of the manger will be changed, 
and after these operations have been finished, the passengers in good 
health will be allowed to go on shore, provided they agree to give informa- 
tion as to what place they are going to reside to the local authority, as 
well as to inform the latter should they become ill during the next period 
of five days after the last case of sickness suffered on board. The 



140 THE MARITIME HEALTH ORDINANCES, 

delegate of the board of health will also take care to give due notice to 
the same authority. If the operations have been done on board the vessel, 
when it carries a stove and a physician directing the process, and the 
delegate is sure it has been well attended to, the vessel will be given a free 
entry and the passengers will be treated as has been just mentioned. 
(Art. 16 of the Ordinances.) 

If the vessel is indemne^ that is to say, that it has not, nor has had, any 
sick cases on board, but comes from an infected port, it will have to go 
through the following requirements : A rigorous visit by the delegate, who 
has the privilege to recommend only the disinfection of the vessel, a fresh 
water-supply, a surveillance of the passengers, and the granting or 
denying permission to the crew to go on shore ; in the latter case, per- 
mission is forbidden except when the necessities of the service demand 
it But should there be a physician and a disinfecting stove on board the 
vessel, the latter will be granted a free entry to port 

In regard to yellow-fever, it is dealt with in a similar manner, as may be 
seen in detail by the paper which I present to this assembly as member 
of the international commission on yellow-fever, and hence I do not enter 
here into the analysis of the document ; but it suffices to say that care is 
taken to prevent the yellow-fever from being carried from the endemic 
centres to those places which, on account of their climate, might be 
susceptible for acquiring it, but also that it should not reach those endemic 
centres which at this particular time do not have the yellow-fever. 

In regard to vessels arriving with typhus, typhoid fever, small-pox, 
scarlatina, or measles, they, or that part considered as contaminated, will be 
disinfected, due notice being given to this effect to the local authority, so 
that the latter may order isolation and other requirements deemed best, in 
order to prevent the propagation of the disease among the natives of the 
port. Afterwards the vessel is given free entry. (Art. 32 of the Ordinances.) 

In regard to small-pox, the disinfecting operations and the removal of 
the sick will be made by persons who have been themselves vaccinated 
or who have had the small-pox. 

If the vessel proceeds from an infected port and brings emigrants, the 
vessel will be given free entry only when the part occupied by the latter 
has been disinfected. 

The vessel which refuses to submit to the previous requirements can go 
seawards, but if its only object is to unload its cargo, it will have to un- 
dergo the respective requirements of this ordinance. 

The Sanitary Service has the following organization : In first, second, and 
third-class ports, a health inspector, known by the title of delegate of the 
board of health, is the executor of the Ordinances. He is himself subor- 
dinate to this board, which in turn depends on the department " de gober- 
naci6n." 

A special ordinance, which is also annexed to this paper, points out the 
duties and powers of the delegates. Doubtful cases are settled by the 
board. 



THE MARITIME HEALTH ORDINANCES. I4I 

Thus it happens that the Maritime Sanitary Service throughout the 
Republic of Mexico is under the care of the federal executive, who de- 
clares, by means of the department '' de gobemaci6n " and advised by the 
Superior Board of Health the existence and the end of an epidemic ; it 
declares whether the national ports are infected or not ; if this foreign port 
or territory should be considered as infected or suspected ; it receives the 
news mentioned at the beginning of this paper, from the Mexican consuls : 
in fine, it has directly under its charge all ports of the Republic, to which 
its easy, rapid, and energetic management is due, as was shown in the ex- 
perience of last year during the months of September and October. 

There are four kinds of ports : First, second, third, and fourth. (Art. 
2 of the Ordinances.) 

The following are the ports of the first class : Veracruz, on the Gulf 
of Mexico, which has a small lazaretto on the island ^'de Sacrificios,'' 
and Acapulco, on the Pacific ocean, which has a lazaretto on the island 
" de la Roqueta." Both are provided with disinfecting stoves. The for- 
mer has a movable one at the lazaretto and a fixed one at the port. 
The latter has a fixed one. 

The following belong to the second class : Progreso and Tampico on 
the Gulf and Mazatlan on the Pacific. They are provided with fixed 
stoves. 

At all ports of the third class, delegates are stationed. They do not 
possess stoves, and hence disinfection is done by other means than those 
obtained under pressure. 

Fourth-class ports are those which have neither disinfecting stoves nor 
delegates. 

At first-class ports, infected vessels may be received ; at second and 
third-class ports, suspected vessels may be received, while at f oxuth-class 
ports only indemne vessels are allowed to enter. 

The disinfecting stoves are of the Geneste and Herscher patterns of 
Paris. By them, the destruction of the germs is obtained, namely, by 
heat and atmospheric pressure. The stove is put in a very wide room, 
which is divided into two compartments by a partition wall, disposed in 
such a manner that by one side of the stove the disinfected articles may 
enter, while they issue from the other end. There is, furthermore, a small 
department where the disinfection is done by means of chemical agents. 

A chapter of the Police Sanitary Ordinances is given in enumerating 
the objects which should be disinfected; the way the work should be 
done ; what the articles are whose entry to port should be prohibited, and 
the conditions for those which may come to land. This is a very inter- 
esting chapter, because it reduces the number of the articles styled sus-- 
ceptibles to those which science and experience of the epidemic have 
shown to be capable of either preserving or transporting the germs of 
these diseases. These ordinances reduce to a minimum the annoy- 
ances imdergone by travellers and the restrictions imposed on commerce. 

This is a synopsis of the requirements obtained by the regulation of the 



142 THE MARITIME HEALTH ORDINANCES, 

Maritime Sanitation, which has been approved by the Superior Board of 
Health, and which the Mexican government has been studying, as is 
mentioned by the president in his message to the Mexican congress. 

These Ordinances will perfect those which are at present in force in 
Mexico, and which I had the honor to make known to this Assembly in 
December, 1892 ; and they will place our sanitary legislation on a level 
with the knowledge which the sanitary sciences have to this day in their 
possession. 



XXVIII. 

REPORT OF THE COMMITTEE "ON SANITARY AND MEDI- 
CAL SERVICE ON BOARD EMIGRANT SHIPS." 

By Medical Director ALBERT L. GIHON, U. S. Navy, Chairman. 

Your committee beg to report the following concise statement of their 
views as to the organization of such a sanitary and medical service on 
board vessels engaged in bringing emigrant passengers to the United 
States, as the experience and intelligence of this age make a necessity 
among civilized and enlightened nations : 

They are of opinion and advise, — 

1. As to the location and dimensions of the quarters for emigrant pas- 
sengers, the number of berths in each, and the provisions for their venti- 
lation and cleansing : 

That the preferable location for such quarters is abaft the midship 
section of the vessel ; that single males' quarters shall be distinct from 
those occupied by women and children, and that if any are forward the 
midship section, it shall be those for single men. 

That there shall never be more than two decks (properly there should 
be only one), occupied by emigrant passengers' berths, with sixteen feet 
of superficial space for each adult on the upper berth-deck and twenty 
feet of such space on the lower berth-deck, with not more than two tiers 
of berths on each deck, the bottom of the lower tier being not less than 
eighteen inches above the deck, with not less than thirty inches between 
the two tiers and between the upper tier and the ceiling of the compart- 
ment, to allow the occupants of the berths to sit upright. 

That no solid partitions or bulkheads shall be placed in any steerage 
compartment to obstruct light and air ; 

That the frame-work of berths shall be of iron, easily removable, that 
the compartment may be completely emptied and thoroughly cleaned after 
each passage ; 

That a steam ventilating apparatus by aspiration shall be introduced 
into all emigrant vessels ; and 

That all compartments occupied by passengers and crew shall be 
lighted by the incandescent electric light by night and day. 

2. As to the location and dimensions of hospitals on board such ves- 
sels and the number of sick-berths for which provision shall be made : 

That the hospitals, or " sick-bays," on board emigrant passenger vessels 
shall be at the extreme after part of the upper deck, thoroughly lighted 



144 REPORT ON SANITARY AND MEDICAL SERVICE, 

and ventilated, with eighteen feet of superficial space for every fifty pas- 
sengers, and not less than four sick-berths or hospital-cots for every hun- 
dred passengers. 

3. As to the number of medical officers proper for the maximum of 
emigrant passengers any vessel should be permitted to carry, being the 
maximum number able to be berthed with regard to health, cleanliness, 
and comfort : 

That there should be one duly qualified medical officer for every two 
hundred and fifty passengers. 

4. As to the professional records which the senior medical officer of 
every such vessel should be required to keep, and his responsibility to the 
health authorities of the port of arrival for the truthful and profession- 
ally accurate statements of such records : 

That the senior medical officer of every such vessel should be required 
to keep (i) a List of Sick^ recording in a bound book, in the order of their 
admission, and on a single line, the name, sex, age, birth-place, date of 
admission to treatment, date of death or discharge from treatment, disease, 
and such remarks as may be necessary to enable the inspecting medical 
officer at the port of arrival to have a clear and complete understanding of 
the case, and (2) a Medical youmal^ in which each medical officer, when 
there is more than one, shall record the medical history, including 
symptoms and treatment of every case, to be approved and signed by 
the senior medical officer at the close of the day's record ; and such 
List of Sick and Mediccd journal shall be submitted to the health 
authorities of the port of arrival, and the accuracy of the statements in 
such records shall be established by oath, and penalties for perjury shall 
be provided. 

5. As to the location and capacity of latrines for emigrant passengers : 
That the latrines, shallow troughs with a continuous flow of salt water, 

shall be on the upper deck xmder shelter, with two water-closet seats for 
every fifty passengers, with a proportionate number for women and chil- 
dren, in a separate locality near their own quarters, inaccessible to men. 

6. As to the number of attendants provided for such passengers, and 
their duties as to policing and cleansing emigrants' quarters : 

That there shall be not less than one berthrdeck attendant for every 
fifty passengers, female attendants, in the same proportion, being exdu 
sively assigned to the quarters for women and children ; 

That the berth-decks shall be thoroughly cleansed every morning, by 
the attendants, never wetted in rainy or damp weather, when they shall 
be scraped, swept, and freshly sanded, and in pleasant weather, washed 
with hot water and quickly dried, the passengers being sent on deck dur- 
ing the operation ; 

That the berth-deck attendants shall be on duty night and day, in rota- 
tion by regular sea-watches, and the attendants on watch be required to 
remove the dejecta of sea-sick passengers without delay, and that benches 
and mess-tables shall be provided and the passengers' food be distributed 



REPORT ON SANITARY AND MEDICAL SERVICE, 145 

by the berth-deck attendants, who shall take away all unused food, and 
carry the dishes to the pantry. 

7. As to additional provisions for the personal health, cleanliness, and 
comfort of emigrant passengers : 

That wash-rooms, under cover, with basins supplied with running 
water, shall be provided on the upper deck, those for men to be separate 
from those intended for women and children ; 

That fresh water for drinking purposes shall be provided in each com- 
partment; and 

That inexpensive mattresses, pillows, these to be serviceable as life- 
preservers, and blankets, shall be provided for emigrant passengers, the 
mattresses to be destroyed after each passage, and the pillows and blan- 
kets to be steamed and washed before being again used. 

While other suggestions as to sanitary provisions might appropriately 
be made, your Committee feel that those indicated are of such urgent 
necessity that they should be insisted upon and put into effect without 
delay. 

All of which is respectfully submitted : 

Albert L. Gihon, M. D., 

Medical Director U. S, Navy, Chairman. 
Frederick Montizambert, M. D., F. R. C. S., D. C. L., 

Superintendent Quarantine Station^ Grosse Island^ Quebec. 
Walter Wyman, M. D., 

Supervising Surgeon-GenercUy U. S. M. H. S. 
S. R. Olliphant, M. D., 

President State Board of Health of Louisiana. 
W. T. Jenkins, M. D., 

Health Officer of the Fort of New York. 



XXIX. 

THE WATER-SUPPLY OF CHICAGO: ITS SOURCE AND 
SANITARY ASPECTS. 

By ARTHUR R. REYNOLDS, M. D., 
Commissioner of Health of Chicago, 

AND 

ALLEN HAZEN, S. B., 
Chemist Water Department World's Columbian Exposition. 

Chicago receives its water-supply from Lake Michigan through tunnels 
at four different points, Lake View, Chicago Avenue, 14th and 68th 
streets, varying from one to four miles in length. Within a few months, 
extensions now in course of construction at Lake View on the north and 
Hyde Park on the south will be completed, and no water will be received 
in the city from a source nearer than two miles from the shore. 

The first tunnel constructed was at Chicago avenue, was five feet in 
diameter, and completed March 25, 1867. A seven-foot tunnel parallel 
to the first was completed July 12, 1874, each two miles in length to an 
intake common to both. 

The Hyde Park tunnel, seven feet in diameter and extending one mile, 
was completed July 22, 1885, and has been the only source of supply at 
that point since. 

The Lake View tunnel, six feet in diameter and extending one mile 
into the lake, was completed April 5, 1892. 

The four-mile tunnel at 14th street was completed December 8, 1892. 
It consists of two tunnels, each six feet in diameter, extending two miles 
to join an eight-foot tunnel, extending to the four-mile crib. 

The capacities of the tunnels are as follows : 

Chicago avenue .... 130,000,000 in 24 hours. 

68th street 72,000,000 " 

Lake View 72,000,000 " 

14th street 140,000,000 ** 

Total 414,000,000 " 

From the Chicago avenue works to the 22d street pumping station 
there is a tunnel seven feet in diameter and four miles in length, passing 
under the Chicago river and the South branch, which is intersected at 
Harrison street works by a seven-foot tunnel from the 14th street works. 



WATER-SUPPLY OF CHICAGO. I47 

The water is pumped into the mains by twenty-six engines, as follows : 

6 pumps at Chicago avenae, with a capacity of 96,000,000 gallons. 
9 " 68th street, " " 77,000,000 ♦« 

2 " 22d street (west side), ** •* 60,000,000 ** 

3 ** 14th street, " " 54,000,000 « 
2 " Central station, Harrison street, 56,000,000 " 

4 " Lake View .... 30,500,000 " 

Total . 353»S«>»oa> " 

The water from the Lake View works supplies Lake View (25th and 
26th wards) and part of Jefferson (27th ward). 

Hyde Park works supply Hyde Park and the town of Lake (29th to 
34th wards). The old city is supplied from Chicago avenue and 14th 
street, with a main leading from 14th street tunnelled under the river to 
the town of Lake (?9th, 30th, and 31st wards). All, however, are so con- 
structed that the water from Lake View may supply Hyde Park, and vice 
versa. 

Before the construction of the 14th street and Lake View tunnels. Lake 
View was supplied by water taken from the lake through several iron 
pipes, laid upon the bottom of the lake, and extending from 1,400 to 
2,000 feet into the lake, about 50 feet apart. 

With the great growth of the city, the Chicago avenue tunnels were not 
sufficient to furnish water for the Harrison and 2 2d street pumping works, 
so that some six years ago a short additional tunnel was extended 3,000 
feet at Chicago avenue for fire emergencies, which, at various times dur- 
ing those years, particularly in 1892, was in use in common with the two- 
mile tunnel, but is now permanently closed. 

From Belmont avenue north, sewers empty into the lake every half 
mile. The largest of these is at St. Lawrence avenue, one half mile to 
the north of the Lake View pumping station. 

On the South side, at 22d street, the 35th, 43d, 51st, 56th, and 71st 
street sewers empty into the lake, while all other sewers empty into the 
river. 

During times of freshet there is a current in the river to the lake, which 
of course carries sewage with it ; consequently water taken from the shore 
intake at Chicago avenue must be more or less polluted with sewage. 
The same will apply to the old intake through the iron pipes at Lake 
View. 

From the junction of Fullerton avenue and the north branch of the 
river, there is a tunnel, extending to the lake, through which water is 
pumped into the north branch, and which has a capacity of 147,750,000 
gallons per 24 hours, which is used to flush that branch of the river when 
required. 

At the junction of the south branch of the Chicago river and the Illi- 
nois & Michigan canal there is a pumping station which pumps water 
from the south branch into the Illinois & Michigan canal, which conducts 



148 WATER-SUPPLY OF CHICAGO. 

it south to the Illinois river, and ultimately to the Mississippi river. 
These works are now pumping 407,936,000 gallons per twenty-four hours, 
and the capacity will soon be increased. The pumping works, except in 
times of heavy rainfall, will, because of the sluggish character of the 
Chicago river, produce a decided current in it from the lake toward the 
pumps, so that it is only in times of freshet that the Chicago river flows 
into the lake. 

The extensions of the various tunnels within the past two years have 
undoubtedly secured for the city a water less liable to sewage pollution 
than was formerly obtained. The available analyses of the water are, 
perhaps, inadequate to accurately measure the improvement, but fortu- 
nately we can apply that most satisfactory of all water tests, the typhoid- 
fever death-rate test. 

The improvements in the water intakes have not all been made at a 
single date, but if we compare the two years ending September 30, 1892, 
and September 30, 1893, we find that during the earlier year the shore 
intakes at both Lake View and Chicago avenue were in common use, 
and the four-mile tunnel was not yet opened, while for the greater part of 
the latter year the shore inlets were entirely closed, and the four-mile tun- 
nel at 14th street and the one-mile tunnel at Lake View were in use. 

The improvement in the death-rate from typhoid fever with these 
changes in the water-supply is well shown by the following table of the 
rates in the various wards of the city, and in public institutions for the 
two years : 



SANITARY MAP OF 

Chicagro 

f^ryenr ending 

ScPT. 30. 1892 
Showing Water lnLah«« 

Sevyer Outlets, and 

9%r Cantage of Oeathft 

from Typhoid Favor, to 

Total Number of OeaiKt 

Trom All Causes In each ^/aroi. 



Public Instiititlont 




Morialil^ Per Cenlages 
trmm TYPHOID rEVER. 



CMiedffo 


e.73 


PMIladetpMa.iBOi/, 


3.B3 


B&ee9n.JS9/, 


4.4^ 


Pam . /««/. 


J.OJ 


Menr Ywk. /««/. 


.ae 


Brifki^H . ieSJ. 


.&6 


I,ondon,/aSJ. 


.fly 


Berlin . /6;9/. 


JO 



SANITARY MAP OF 

Chicag-o 

tor year eneting 

Sept. 30. 1893. 

Showing Water^ InLahet. 

Sewer Outlets, and 

Percentage ot Deaths 

Trom Typhoid Tever. to 

Total Number of OealK* 

from All Causes in each Ward. 

t f 




Mortality /^rC«iUaffe9 
rn»m TYPHOID TtVEH. 



Chieape 


a.eo 


/>M4idelfiJkla./8»S. 


Z.B9 


B—i9n.l69Z, 


I.Zt 


/»arla . /6M, 


1,40 


New York, /89S. 


,90 


Broekli/n, 1892, 


^ 


I.0nd»n,/8aS, 


,49 


Berlin . /«««, 


.4a 



WATER-SUPPLY OP CHICAGO. 



149 



TaUe showing deaths from all causes and from typhoid fever by wards for two years ^ 
ending September ^Oy i8g2, and September 30^ iSg^. 





Year Ending Sept. 


30, 1892. 


Yeak Ending Skpt. 


30, 1893. 


Ward. 


^i 


^1. 




53 




oS^ 

^|i. 




si 


Il^s 


^jn 


1=3 


m 


feists 




Q 


Q 


& 


Q 


Q 


£ 


I 


329 


9 


2.73 


3*0 


4 


I.2S 


2 


439 


20 


4*56 


:^3 


9 


2XX> 


3 


498 


34 


6.83 


9 


1.86 


4 


424 


20 


4.72 


537 


10 


2.29 


I 


967 


79 


8.17 


843 


20 


2.37 


i»i33 


73 


6.44 


I.I36 


36 


3-17 


I 

9 


712 


43 


6.04 


680 


19 


2.79 


682 

912 


i 


^ 


682 

850 

1,180 


Ji 


3-2S 


10 


1,019 


6.30 

6^4 


3J 


2.88 


II 
12 


^^ 


37 
59 


^ 


16 
21 


324 
2.17 




^ 


'd 


6.U 
7.14 


880 


23 
23 


3-36 


\l 


960 


73 


7.60 


1,187 


25 


2*51 


1,306 


• 97 


7.43 


1 


2.02 


IS 


594 


43 


7-24 


438 


1^3 


413 


20 


4.83 


375 


8 


\\l 


19 


969 


40 


4.13 


931 


II 


20 


457 


4J 


9.19 


392 


13 


3-32 


21 
22 


1^ 


38 

i2 


6.96 
6.51 


5" 
^5? 


13 


r4t 


23 


I 


68 


8.18 


2.43 


24 


28 


7.59 


332 


6 


1.81 


^ 
S 


24 


5-74 


423 


II 


2.60 


710 
188 


38 
12 


m 


% 


19 
7 


2.90 
3.10 


227 


8 


3-5* 


230 


4 


1.74 


29 


629 
1,168 


24 


3.81 


704 


16 


2.27 


30 


52 


4.46 


1,441 


34 


? 


31 


i 


23 


5.24 


597 


II 


32 


25 


5-39 


P 


12 


2.64 


33 


33 


531 


22 


Cor. cases 


632 
2,404 


35 
400 


M 


670 
2,331 


23 
153 


..3 


Pub. Inst's.... 


1,550 






1,933 
















Total for en- 














tire dty. 


26,646 


1,790 


6.7* 


26*977 


712 


2.64 



The total number of deaths by months since 1890 are shown by the 
following table : 



ISO WATER-SUPPLY OF CHICAGO. 

Table shewing deaths from typhoid fever in Chicago by months. 



1890 



1891 



1892 



1893 



January — 
February... 

March 

April 

May 

June , 

July 

August.... 
September 
October.. . 
November. 
December. 

Total. 



136 
103 

'?^ 

"5 
95 
72 

67 
47 



61 

408 
167 
200 
182 
198 
171 
1^0 



70 

55 
211 

% 

47 



1,008 



1.997 



1,489 



41 
30 

5? 



i 



It is most unfortunate for this comparison that the old supplies were 
partially in use during the first two months of the latter year before the 
four mile tunnel was opened, and we may believe that if this had not been 
the case, the comparison would have been still more favorable to the 
improved supply. 

It is a well known fact that people using a water-supply to which they 
are not accustomed are often more susceptible to any infection which it 
may contain than are those using such water regularly. A striking illus- 
tration of this was furnished by Philadelphia in the centennial year, when 
the typhoid death-rate was nearly doubled, while in Chicago, the present 
year, for the first five months of the Fair period the rate has been less 
than half as high as for the corresponding months of the preceding year ; 
and for the entire years under consideration, in spite of the vast numbers 
of visitors continually present in Chicago, there has been a reduction of 
over sixty per cent, in the percentage rate. 

The mortality percentages from typhoid fever for the two years, as 
given above, have been put upon two maps of the city, showing the water 
intakes and sewer outlets in use for the respective years. 

The reduction in the death-rate from typhoid fever in one year of over 
sixty per cent, is most striking, and it can hardly be doubted that the 
improvements in the water-supply have been the chief, if not the only, 
cause, in this gratifying reduction. 

It is to be noted particularly that there is no very marked local distri- 
bution of the disease. In the earlier year, there was not a ward in the 
city without an excessive rate. The so called best wards suffered almost 
equally with the poorer wards, and the wards on the lake shore were not 
more favored than those along the Chicago river. The only general dif- 
ference to be observed was that those wards supplied with water from the 
Hyde Park intake had somewhat lower rates than the rest of the city ; 
and during the past year, with the improved condition of the other intakes, 
this difference has disappeared. 



WATER-SUPPLY OF CHICAGO. 151 

As there is no marked local distribution of the typhoid fever, so there 
were no exceptions to the general improvement with better water-supply. 
There was not a single ward in the city which did not show a substantial 
reduction, although, as might be expected with such a complex problem, 
the percentages in the different wards varied somewhat. 

The lessons of the maps may be summed up as showing a general 
cause of the typhoid fever in the city only slightly affected by local con- 
ditions and a general improvement in the death-rate with improved water- 
supply without any local exceptions whatever. Stronger evidence could 
hardly be produced, even if additional proof was required, to show the 
causal relation between the contamination of the water-supply and the 
typhoid fever. 

The mortality percentages from typhoid fever in a number of cities for 
the last year for which we have the data were as follows : 



% 


"rt 


CO 




t« 


a 


1^ 


^ 


fi ^ 


gS 


•'JS 


.si 


S§ 


|3 


> 


Q 



Q 



|4 



Chicago 

Chicago 

Philadelphia 

Boston 

Paris 

New York. . 
Brooklyn... . 

London 

Berlin 



1892 


26,646 


1893 


26,977 


1892 


24.30s 
11,236 


1892 


I89I 


54,443 


1892 

1892 


44,317 
20,857 


1892 
1892 


» 



1,790 
712 

539 
137 
549 

424 
137 



6.72 
2.64 
2.22 
1.22 
1. 01 

t. 

.49 
42 



The cities having the lowest typhoid fever death-rates given above — 
London and Berlin — use only filtered water. London draws nearly all of 
its water for some four or five millions of people from the two grossly 
polluted rivers, the Thames and the Lee, and after filtering it, supplies it 
to a population that is almost free from typhoid fever. 

Among the improvements which will eventually still farther protect the 
purity of Chicago's water-supply, may be mentioned the drainage canal. 
After its completion, with the construction of a complete system of inter, 
cepting sewers along the entire lake front, the sewage will be turned from 
the lake to the Mississippi river. 

In the meantime, it may be a question worth considering by the engi- 
neers whether filtration would not be as cheap and effective a means of 
improving the supply as the farther extension of the tunnels. 



XXX. 

ON THE REMOVAL OF PATHOGENIC BACTERIA FROM 
DRINKING WATER BY SAND FILTRATION. 

By GEORGE W. FULLER, S. B., 

Biologist, Lawrsncb Experiment Station, State Board of Health 
OF Massachusetts, 

Lawrence, Mass, 

That drinking water is a carrier of some disease there can be no doubt. 
Numerous laboratory experiments by many investigators indicate that the 
bacteria generally attributed to be the specific organism of typhoid fever, 
Asiatic cholera, and other diseases live in ordinary drinking water for 
many days. The results of long continued investigations at the Law- 
rence Experiment Station show that the typhoid bacillus is able to live in 
the water of the Merrimack river, in greatly diminished numbers, for a 
period of at least 24 days. Other investigators, using different water and 
different conditions, estimate the length of life of this germ at from 3 to 
80 days. The duration of life of the cholera spirillum in various waters 
has been observed to be from 2 days to 7 months. 

Modem hygiene demands that drinking water shall be free from patho- 
genic bacteria ; and the means by which such water can be obtained are 
worthy of our most careful consideration. 

In some localities satisfactory supplies of pure water can be had from 
driven wells and from surface water taken from water-sheds which are 
free from human habitation. It is rare, however, that great cities 
with their large suburban population can obtain a sufficient quantity of 
perfectly safe drinking water from either of these sources. Many water- 
supplies drawn from polluted sources have been introduced in America in 
recent years with the belief that the bacteria were removed from the water 
on its passage to the consumers. It is true that a certain degree of bac- 
terial purification is effected by dilution ; by storage in a reservoir holding 
one or two weeks' supply ; and by passage under pressure through miles 
of iron pipe. But the experience of numerous cities, involving the loss of 
hundreds of human lives, shows conclusively that all of these conditions 
taken together are insufficient to render an infected water safe, at all 
times, for drinking purposes. 

At the present time many cities and towns, and the number is constant- 
ly increasing, are obliged to face the problem, How can the pathogenic 
bacteria be best removed from a polluted drinking water ? From the re- 
sults of long continued scientific investigation, together with the exper- 



REMOVAL OF PATHOGENIC BACTERIA, 153 

ience of certain European cities it is fully believed that the requirements of 
modem sanitary science are satisfactorily fulfilled by properly conducted 
sand filtration. 

Sand filtration was first introduced near London by James Simpson in 
1S39. ^^ ^s ^^ practice in Europe to pass the water through fields of 
thoroughly underdrained sand from 2 to 5 feet in depth. The surface of 
the sand is kept continually covered with water. The sediment in the 
unfiltered water is deposited on and very near the surface. This gradu- 
ally increases the resistance to the passage of the water through the sand 
until a point is reached when the quantity of water yielded by the filter is 
so small that it is necessary to scrape the filter, that is, to remove the 
upper layer of clogged material. 

During the past forty years many filter plants have been constructed in 
Europe, and numerous improvements in the filtration of water have been 
made, particularly during the past decade. This is largely due to the aid 
of bacteriology, which enables us to determine the actual efficiency of 
filters ¥dth regard to the removal of bacteria. The operation of many 
filters is quite satisfactory, as is shown both by the low death-rates from 
those diseases conveyed by drinking water, and by the results of numer- 
ous bacterial analyses. 

The water from the river Thames, the source of a part of the London 
water-supply, was examined bacterially for several years before and after 
filtration by Prof. Percy Frankland. The average results for the years 
1 886, 1887, and 1888 showed that the filters removed 97.6 per cent, of 
the bacteria in the unfiltered water. During this period the average 
death-rate from typhoid fever in London was very low, namely, 1.6 per 
10,000 inhabitants. 

The operation of the Berlin filters has also been watched very closely, 
particularly the works at the Stralauer Thor. These filters, which are 
now discontinued, were under the direction of Piefke, the eminent engi- 
neer under whom it was my privilege to study for a short time. Through 
the investigations of Piefke and the bacteriologists of the Hygienic Insti- 
tute at Berlin our knowledge upon the removal of bacteria from water 
by sand filtration has been much enlarged. 

In 1887 the State Board of Health of Massachusetts established an 
experiment station at Lawrence. One of the chief objects of this was 
to study the laws of filtration. The experiment station was designed by 
Mr. Hiram F. Mills, A. M., C. E., the distinguished engineer who has 
directed the investigations. During the earlier history of the work atten- 
tion was devoted largely to sewage filtration. The fact that tjrphoid fever 
has been epidemic in certain Massachusetts cities, as has been described 
by Professor Sedgwick, has given an increased impetus to the study of 
water filtration for the last two years. 

In the fall of 1887 a tank six feet deep and seventeen feet four inches 
in diameter was filled with mixed coarse and fine sand, and contained a 
layer of loam eight inches thick, the top of which was six inches below 



154 REMOVAL OF PATHOGENIC BACTERIA, 

the surface. The total depth of the filtering material was five feet. 
Beginning in January, 1888, water from the Merrimack river which had 
passed through the reservoir and service pipes of the Lawrence Water 
Works was applied to this filter sixteen hours a day. The filter was 
allowed to drain during the remainder of the time, and the pores of the 
sand to fill with air. Such a filter is known technically as an intermittent 
filter in distinction from the continuous filters, the surfaces of which are 
constantly covered with water. 

The number of bacteria in the effluent from this filter was very low — 
usually below ten, and at times it was sterile. In 1891 elaborate prepara- 
tions were made to settle with certainty whether any of the bacteria found 
in the effluent came down through the filtering material with the applied 
water, or whether they had their origin in the underdrains. Great care 
was taken to prevent contamination of the effluent by air and dust. The 
average results of 186 bacterial determinations indicated that from May 
to October, 1891, the applied water contained 175 and the effluent 4.7 
bacteria per cubic centimetre. This was a removal of 97.3 per cent of 
the bacteria in the unfiltered water. 

To obtain more definite knowledge upon the subject Merrimack river 
water, taken directly from the canal, was applied to this filter, commenc- 
ing November 13, 1891. The results of daily investigations upon the 
number and species of bacteria in the water before and after filtration 
may be stated as follows : 

1. The application of river water instead of city water which increased 
the number of applied bacteria more than tenfold, was followed by no 
increase whatever in the total number of bacteria in the effluent from the 
filter. 

2. Of the 102 bacterial determinations of the effluent from November 
13 to December 31, inclusive, 58 indicated that the filtered water was 
sterile. The average results for this period showed a removal of 99.97 
per cent, of the applied bacteria. 

3. No relation could be found between the rates of flow and the number 
of bacteria in the effluent. 

4. As a result of numerous species determinations it was found that 
three of the most prominent kinds of bacteria in the river water were not 
present in the filtered water. Among these species was B, coli communis^ 
the leading species in human faeces, and which formed, during November 
and December, 189 1, 39 per cent, of the bacteria in the water of Merri- 
mack river at Lawrence. 

5. The presence of the very small number of bacteria in the effluent 
was satisfactorily explained by their specific similarity to those present 
in the air, the outlet pipe, and the underdrains. 

The determinations of the bacteria in the river water and in the effluent 
were made on the same nutrient gelatine, grown for the same length of 
time, and at the same temperature. From this evidence it was concluded 



REMOVAL OF PATHOGENIC BACTERIA. 155 

that with these filtering materials and under these conditions all the 
bacteria of the Merrimack river water may be removed by filtration. 

This filter was continued during the following year, and the degree of 
bacterial removal remained most satisfactory. The maximum amount of 
water purified by this filter has not exceeded 300,000 gallons per acre 
daily. The adoption by cities and towns of water filtration through such 
materials would be very costly, and a large portion of our attention has 
been devoted to the study of filtering materials coarse enough to filter a 
municipal water-supply economically while removing the pathogenic 
bacteria. 

Fourteen new water filters were constructed during 1892. The con- 
struction and operation of these new filters as well as of the older ones were 
such as to throw as much light as possible upon the laws of filtration. 
Since the removal of bacteria is one of the most important points in the 
filtration of water, the investigations, of which I have charge, were 
arranged so as to allow a direct comparison of the power of removal of 
bacteria from water under dijfferent rates of filtration, with sands of 
different degrees of coarseness, with different depths of the same sand, 
with the presence of loam layers, and with intermittent and continuous 
filtration. 

The actual efficiency of the filters was tested by the application of 
typhoid-fever germs and other prominent species, and by observations 
upon their passage through the filters. Pure cultures of the micro-organ- 
isms were grown in dilute bouillon solutions, and 25 or 50 cubic centi- 
metres of these solutions containing millions of germs were applied, usu- 
ally in a gallon of water, to the filters. Bacterial examinations of the efflu- 
ents were made at frequent intervals for several days. 

It is obviously impossible to discuss here in detail these results which 
are presented in the reports of the board, and it is the purpose in this 
present paper to outline the methods of investigation and summarize the 
results. 

During the first five months of 1892, fifty-five experiments upon the 
passage through the filters of pure cultures of bacteria in single doses 
were made. The results are summarized in Table No. i. 



156 



REMOVAL OF PATHOGENIC BACTERIA, 



TABLE No. I. 

Average Results of the Application of Pure Cultures of Bacteria in Single Doses to Water 

Filters, 



Number of Filter. 



i8A.. 
35 



^ 



33A.. 
34A., 

%:■:. 

39-.. 
40... 



Averages and Totals. 



Number of Experiments. 



o 



1 



19 



a 
SI 



14 



3 

iS 



55 



oq § 

ill 

55 



»3i 

46 
25 

146 
136 
los 

73 
93 
93 



914 



Ill 






142,600 

3*630 

9,270 

275,000 

227,000 

77.630 

145,800 

121,000 

44.500 
42,800 
57.000 



104,200 



V 






99.560 

loaooo 

100.000 

100.000 

100.000 

98.020 

99-330 

99.999 

99AX) 

99-090 
98430 



99-480 



These experiments were very severe tests upon the efficiency of the 
filters in removing bacteria, because the number applied was probably 
many times greater than would ever occur in practice, and furthermore, 
the organic matter introduced with the bacteria served them as a food 
material. 

The experiments made during the latter portion of the year are much 
fairer, because the bacteria were applied in small and long continued 
closes at frequent intervals, and less organic matter was put on the 
filters. Pure cultures of the different species of bacteria were obtained 
by inoculation and growth for four days at 20° C. in solutions of one tenth 
per cent, peptone and two tenths per cent, glucose in city water. It was 
found that this solution after four days contained on an average about 
20,000,000 bacteria per cubic centimetre. This solution was applied to 
the filters in the proportion of one part to three thousand parts of water 
at intervals of one or two hours according to the rate of filtration. Every 
cubic centimetre of water which went onto the filters during the experi- 
ments contained as a rule about 6,000 bacteria of the pure culture in 
addition to those water bacteria ordinarily present. It was determined 
also that the food material which was applied with these germs did not 
increase the organic matter in the river water beyond the limits of varia- 
tion which have been occasionally observed in it from month to month. 
Table No. 2 contains the average results of five analyses of the river 
water before and after adding to it this solution. 



REMOVAL OF PATHOGENIC BACTERIA. 
TABLE NO. 2. 



157 





Parts per 100,000. 




Ammonia. 


Chlorine. 


Nitrogen as — 


Ox. 




Free. 


Alb. 


Nitrates. 


Nitrites. 


Cons. 


River water before inoculation. 
River water after inoculation.. . 


.0056 
.0062 


.0172 
.0203 


•19 
.19 


.015 
.015 


.0001 
.0001 


•52 
•54 



Since September, 1892, B , prodigiosus has been the species of bacteria 
which has been used almost without exception in these experiments. 
The reasons for using this species are (i) the ready and accurate means 
for its differentiation ; (2) its great similarity to B, typhi abdominalis in its 
mode of life in the river water — ^neither species multiplies, but both con- 
tinue to live in gradually diminishing numbers for about twenty days ; and 
(3) the fact that it has never been found native in this country, and we are 
therefore reasonably sure that the bacteria of this kind, when found in the 
filtered water, must have passed through the filter with the applied doses. 

Beginning September 16, 1892, repeated doses of B.prodigiosusyf^x^ 
applied at frequent intervals for ten hours daily to the several water fil- 
ters. Throughout the experiments, from September 16 to December 31, 
four examinations were made daily of each of the effluents at a time when 
the applied doses were passing through the outlet pipe. In Table No. 3 
the results are summarized. 

TABLE No. 3. 
Average Results of the Daily Application ofB. Prodigiosus with the Rates of Filtration, 



Number of Filter. 



V 



1 1 

lit 



55 



$60 



< 



t 

S a 

« c« 






U 5 

c 
^ B 



I8A. 

33A.. 
34A. 
35A. 



ilt 



39. 

40. 
41. 
4a. 



ATerages and totals. 



1,300,000 
1,700,000 
1,500,000 
1,200,000 
2,400,000 
1,700,000 
1,800,000 
1,900,000 
1,700,000 
i,7oo»ooo 
1 300^000 



i,70o»ooo 



160 
212 
260 
120 
288 

IC2 



256 



3.660 
5.710 

6»220 
3.370 
4.700 
6,230 
3.630 

8|o6o 



2.372 



S.700 



99.84 
9978 
99.83 
99.95 
9990 

^ 

99.83 
9991 
99-97 
99.75 



99.87 



158 



REMOVAL OF PATHOGENIC BACTERIA. 



Numerous determinations have been made of the ordinary water bac- 
teria present in the water before and after filtration. Beginning in June, 
1892, all of the effluents have been examined once a day or oftener. It 
has been found that the true degree of bacterial removal is observed 
somewhat by the presence in the effluents of bacteria which do not appear 
to come down through the filter, but seem to have their origin in the 
underdrains where they continue to live upon the very small amount of 
food present. 

In Table No. 4 the average results are presented of more than 5,000 
representative samples of the effluents from the several water filters. 



TABLE No. 4. 

Summary of the Results of the Bacterial Examinations of s>ooo Representative Samples of 
Effluents from the Several Water Filters, 



Number of Filter. 



Bacteria per c. c. in 
River Water. 



Per cent. 
Removed. 



8 

18A 

33A 

34A 

t^:::::::::. 
i:::::::::::: 

39- 

40. 

41 

42 

Averages., 



5.350 
9.960 
8,410 
9.160 
9,310 
8,510 
8,540 
8,860 
83io 
9,010 
10,050 
8,750 



8,780 



99.83 
99.22 
99.29 
99.57 
99-45 
9927 
99-34 
99.03 
99.01 
99.26 
99-51 
97.74 



99.21 



As has been stated already the sediment in the unfiltered water is 
deposited upon and very near the surface of the filter. The surface sand 
in time becomes so clogged that it is necessary to scrape off one eighth to 
one fourth of an inch. In Berlin it is believed that the efficiency of the 
filter depends upon the scum which is formed on the surface of the filter. 
In some places abroad it has been found that the effluent contains at 
times as many bacteria as the unffltered water just after scraping the 
sand. At Lawrence the efficiency of the filters, under the existing meth- 
ods of operation, varies but very slightly during the period between 
scrapings. In Table No. 5 are presented the average bacterial results for 
three days before scraping and for three da3rs after scraping. 



REMOVAL OF PATHOGENIC BACTERIA. 



^9 



TABLE No. s. 

Average Number of Bacteria per Cubic Centimeter in the Effluent fran^ each Filter for the 
J Days before Scraping and j Days after Scraping. 



Number of Filter. 



8) 



I 



Water Bacteria. 



= 12' 
I" 

fe"5g 
.2 o 

125 



§•0.5 



I 



13 s^ 

§•3 'a 



•I 
§ 

CO 



I 



B. PRODIGIOSUS. 



^ >. «j 

fl^ ex 

n 



I 






p?.. 



is" 

§•3 "a 



33A 

34A 

%:::::::::::::::::::::■ 
i::::::::::::::::::::::::: 

39- 

40 

41 

4i 

Totals and averages. . . . 

Averages per cent, removed 



3 


31 


45 







5 


32 


42 




0.4 


4 


SO 


77 




1.0 


4 


39 


52 




3-9 


2 


21 


48 







6 


47 


121 


4 


4.2 


8 


5? 


90 


8 


3.6 


3 


48 


^ 


3 


1.3 


5 


20 


2 


0.4 


2 


109 


233 


2 


13.0 


42 


44 


75 


32 


2.8 




99.68 


99.46 




99.96 



3-0 
04 

7.3 
2.3 
14 

34^ 



6.7 



99.87 



It is to be stated, however, that in the case of the Lawrence filters it is 
the upper portions of the sand which largely accomplish the bacterial 
purification. This is brought out most clearly by Table No. 6, which 
shows the number of bacteria per gram found in the sand of a continuous 
filter which had been in operation from May 2 to October 26, 1892. 
This filter was scraped on October 15, and was again clogged on October 
26, the date of examination. 



Depth from surface. 


TABLE NO. 6. 


Bacteria. 


Xinch, 

% " 

1 " 

2 " 




1,100,000 

320,000 

140,000 

21,000 


4 " 
6 " 




4,000 
1,600 



During the present year a large water filter, designed by Mr. Hiram F. 
Mills, has been constructed by the city of Lawrence. The construction 
of this filter, two and one half acres in area, and with a capacity of 
5,000,000 gallons of water daily, is based to a large extent upon the 
results obtained at the Lawrence Experiment Station. This filter, the 
only one of its kind in America, differs chiefly from those in Europe in 
that it is operated intermittently, and the pores of the sand allowed to 



l6o REMOVAL OF PATHOGENIC BACTERIA. 

fill with air every day. This facilitates the oxidation processes, and 
appears to have an advantage over continuous filters because it removes 
at times more of the organic matter which accumulates at the surface of 
the sand. 

In studying the death rates of the large cities which draw their drink- 
ing water from polluted sources, we learn that London and Berlin, which 
filter their water, had death rates from typhoid fever in 1891 and 1892 of 
I.I and 0.93 per 10,000 inhabitants respectively. Chicago and Philadel- 
phia, on the other hand, without filtration, had typhoid fever death rates 
during this period of 13.0 and 5.7 per 10,000 inhabitants respectively. This 
shows very clearly that a great safeguard against water carried diseases 
is afforded by scientifically conducted sand filtrations. The most strik- 
ing example of this is the experience with cholera at Hamburg and 
Altona which is familiar to you all. 

In summing up our present knowledge upon the removal of pathogenic 
bacteria from drinking water, we may state that in addition to the experi- 
ence of certain European cities, the Lawrence investigations, covering a 
period of more than five years, and including the bacterial examination of 
more than 11,000 samples of water, indicate that it is entirely practicable 
to construct filters that will economically purify water, and remove more 
than 99 per cent, of bacteria which may be present in the unfiltered 
water. 



XXXI. 

PROPHYLACTIC AND THERAPEUTIC VALUE OF FOOD. 

By ELLEN H. RICHARDS, M. S., 

Institute of Technology, 

Boston^ Mass. 

The views now held concerning the causation and prevention of disease 
lead us to hope that a new era is dawning for the study of food in its re- 
lation to health and sickness. 

Mrs. Abel has chosen for the motto of the series of Rumford Kitchen 
Leaflets the following saying of Donders, which was first quoted by Voit : 
" He who works with all his strength on the development of our knowl- 
edge of food and nutrition, and who also persistently strives to apply the 
results of investigation, is working on a broad basis for the development 
of mankind." 

No body of men can be more interested in the application of scientific 
knowledge to daily life than the members of the Public Health Associa- 
tion, or more keenly alive to the liability to mistake on the part of enthu- 
siasts, and certainly no body of men can so warmly sympathize with those 
who are striving to bring well-known facts into general circulation in the 
face of difficulty and discouragement. As Count Rumford so well stated 
it : '' The slowness with which improvements of all kinds make their way 
into common use, and especially such improvements as are the most cal- 
culated to be of general utility, is very remarkable, and forms a striking 
contrast to the extreme avidity with which those unmeaning changes are 
adopted, which folly and caprice are continually bringing forth and send- 
ing into the world under the auspices of fashion." 

But Count Rumford worked almost alone, and far in advance of his 
time, while we can count on the sympathy and support of scores of able 
men, and it is for that reason that we appeal to you for cooperation, sug- 
gestion, and criticism. The world at present needs most of all what I 
have elsewhere called a standard of health, a normal " well-being." 

Given a well-built, smoothly-working bodily machine, placed under good 
conditions in a wholesome environment, and it is chiefly a question of 
good food as to how nearly the standard can be kept up. 

As a good workman can do better work with a poor tool than a poor 
workman can do with a good tool, so a man with skill derived from knowl- 
edge can often make better use of a body crippled by accident or inherit- 
ance than his neighbor can of a perfect equipment. Many a structure is 



l62 PROPHYLACTIC AND THERAPEUTIC VALUE OF FOOD, 

Strengthened, by a brace here and a bolt there, until it long outlasts a bet- 
ter-built one : so the right kind and quantity of food, with rigid abstinence 
from irritating or clogging substances, may so strengthen a weak heart or 
a feeble constitution that the natural term of life may be reached in com- 
parative comfort. On the other hand, the delicately adjusted machine 
may be thrown into disorder by a very slight indiscretion, which may not 
matter for once, but which, repeated, wears a groove which deepens more 
and more until it is in danger of stopping the machinery. 

A great need of the present time is a better standard of health, a test 
measure of the duty (used in the engineering sense) of the human body. 
The engineer knows how much his engine is intended to do, and he 
chooses that fuel and that lubricant which will enable the task to be ac- 
complished. Each hmnan machine has a certain capacity of work, a cer- 
tain load under which it works best ; each individual can, generally speak- 
ing, if he will, control this load or strain so as to get the full duty of the 
machine. Here also it is fuel and lubricant, that is, food and enjoyment 
of work. 

To be well means to have good spirits, good temper, and a certain elas- 
ticity or capacity to do more than the normal without passing the limit of 
recovery. In this '< well-being," this ''feeling like a fighting cock," in 
homely phrase, lies, in the main, as we believe, the secret of resistance to 
disease. Therefore, to keep the body in good working condition seems to 
be also to render it most resistant to the inroads of disease. The power of 
accommodation is such in this delicate machine that the most diverse 
substances can be utilized, and the range of substances found useful for 
human nutrition is very wide, so wide that man has jumped to the con- 
clusion that it made no difference what he ate ; and while to a certain ex- 
tent this may be true in a state of robust health and active ezerdse, it is 
far from it when once the balance has been disturbed and the machinery 
is working badly ; so that in the case of inherited weakness or of acciden- 
tal disability food becomes of more importance, and the cause of public 
. health would gain much, and public temper still more, if this fact could be 
generally recognized. 

It is the day of ^ small things "—quantities formerly considered insig- 
nificant are now held responsible for great disorders. 

An excess of food over the supply of chemical agents in the alimentary 
canal causes imperfect decomposition, and leads to irritability, if it does 
not leave poisonous products, to be more or less absorbed into the blood ; 
a danger tiie greater because often quite unsuspected. 

This intimate connection of good food and good temper might be em- 
phasized to advantage both in school and in society. 

T^^ prophylactic valueoffood is^ tken^ to keep the human body in a high 
cofuiitum of health. For this there seems to be no general rule, since in- 
dividual idiosyncrasies and mental conditions exercise a marked influence 
on capacity for utilization of nourishment The main <^ject to be gained 
is to establish a higher standard of health in the community, to make as 



PROPHYLACTIC AND THERAPEUTIC VALUE OF FOOD. 163 

widely known as possible the fact that much of the ill-health now prev- 
alent is needless, that a little self-denial, a little more attention to the 
rules of hygiene, a little more living in the open air, would cause a large 
part of the disturbances of health now so common to disappear. 

Self-indulgence, and a deep-seated superstition that medicine can take 
away all evil consequences, lead men to swallow the pill and throw away 
the sound advice which usually accompanies it. 

A man will attribute a headache in the morning to anything rather than 
to the dinner of the night before. 

Drugs, however useful in emergencies, can never take the place of the 
daUy food ; if that is dean, wholesome, and right in kind and quality, 
there is little chance for disease to find a foothold ; but once let the nor- 
mal life be disturbed, and the importance of the food taken rises rapidly. 

The therapeutic value of food it is hardly possible to estimate. It is 
often the one determining factor in the question of recovery — ^more often 
than one likes to think, in view of the ignorance and carelessness so often 
seen in feeding the sick. 

Still more in sickness than in health food should be such that it fur- 
nishes sufficient nourishment, but not more than can be assimilated by a 
system wedcened by disease. 

A knowledge of die right proportions of the essential food substances, 
and of the absolute quantity or food value of the food given to the very 
sick, is necessary to the physician, if not to the nurse. How many a life 
has been lost because of a lack of this knowledge, the world will never 
know. 

Therefore we believe, that when medical schools teach so thoroughly 
the principles of physiological chemistry and of the science of nutrition, 
already well known, that the physician becomes perfectly conversant with 
the food values of the different articles of food which he prescribes, and 
with the appearance they present when they are properly prepared, then 
the percentage of recovery will be largely increased. 

At present there are comparatively few persons who are called upon to 
feed the sick, to whom a glass of milk or a pound of beef represents any 
definite amount of food materials. Still fewer who can tell how much 
food-value a glass of lemon jelly or wine whey represents, and yet the 
adult patient is dependent upon the attendant even more than the week- 
old infant for the requisite nutrition. 

The time is surely ripe for some definite experiments in this line, and 
as it is so often the first step that costs, the first plunge that gives the 
cold chill of disenchantment or disappointment, I venture to make the 
next step, that of criticism, easier, and have given in the following tables 
some suggestive combinations, in the hope that some one favorably situa- 
ted and philosophically inclined may carry on the investigation. 

From the experiments made by the best investigators, it seems probable 
that only about one third of the daily ration is available for kinetic force — 
that is, that only about one third of the total energy contained in the dsuly 



164 PROPHYLACTIC AND THERAPEUTIC VALUE OF FOOD, 

food can be utilized in digging trenches, carrying bricks, climbing moun- 
tains, designing bridges, or writing poems and essays. 

The other two thirds is used up in the internal work of the body, the 
action of the heart, lungs, and the production of the large amount of heat 
necessary to life. 

If this is the case, then we may make out a life ration, or that amount 
of food which is necessary in order to keep the human machine in exis- 
tence without any special accomplishment of either body or mind, and 
a work ration which includes the amount of food required by the human 
machine in order to produce results either physical or mental. 

For this climate, and for the habits of our people, I have estimated 
this life ration as approximately, — 



Protcid. Fat Carbo-hydrate. 


Calories. 


75 grams. 40 grams. 325 grams. 


2,000. 


Lnd the maximum and minimum work ration as, — 




Proteid. Fat Carbo-hydrate. 


Calories. 


125 grams. 125 grams. 45 grams. 


3»SOO- 


no " 90 « 420 " 


3,000. 



An examination of the actual dietaries of some of the very poor who 
eat just enough to live, without doing any work, shows that in twelve 
cases the average was, — 

Proteid. Fat Carbo-hydrate. Calories. 

81 grams. 88 grams. 272 grams. 2,257. 

The forty-eight grams of fat would thus seem to be the chief source of 
the little energy these people showed. However far out we may be in 
this calculation, it will serve its purpose as a working hypothesis to enable 
us to determine the true standard. Taking this as a basis, I have made 
out the following tables of some dietaries for the sick — that is, for the gen- 
erality of cases where no very wide departure from normal diet is required, 
where only a lessened quantity and a liquid form are indicated. 

These tables show how difficult it is to secure sufficient food in a liquid 
form, and how important it is to turn some of our scientific study in this 
direction. 

The full allowance of three quarts in twenty-four hours must be taken 
of nearly any sort of liquid food, and no one kind is sufficient in itself, so 
that a variety is required. 

For instance, three quarts of mUk would give, — 

Proteid. Fat Carbo-hydrate. Calories. 

102 grams. 108 grams. 132 grams. i}953' 

Which is about the right amount of calories, but far too much fat and too 
little carbo-hydrate according to most authorities. 



PROPHYLACTIC AND THERAPEUTIC VALUE OF FOOD. 165 

It would be necessary to use skimmed milk, and the danger of partial 
decomposition or deterioration of the milk while waiting for the cream to 
rise is a serious objection to general use, unless milk from the centrifugal 
separator can be had. On the other hand, if three quarts of beef broth 
or consomm^ were given, the patient would have only, — 

Proteid. Fat. Carbo-hydrate. Calories. 

123 grams. 3 grams. . . . 532. 

This would ftumish too little fat and no carbo-hydrate, and only about 
one fourth of the total amount of heat necessary. The soup as made at the 
Munich hospital is much better, as it contains, — 

Proteid. Fat. Carbo-hydrate. Calories. 

21.6 grams. 21.6 grams. 108 grams. 730. 

One pound of lean steak and three quarters of a pound of rice (weighed 
uncooked) yield the full life ration. 

To illustrate how little these points are appreciated we have only to 
turn to one of the best of invalid cookery books just published, and find 
that the rations which are given as guides to nurses, when the physician 
has left the food to their judgment, prove far too low. For instance : 



Proteid. 


Fat. 


Carbo-hydrate. 


Calories. 


24.5 grams. 
66.S « 


28.5 grams. 
23.S " 


83s " 


631. 
831. 



These are only one half, or even one third enough, according to theory, 
and the amount of liquid is also below the standard. 

I was pleased to find in an article by Dr. W. Prausnitz, on the food of 
German hospitals, calculations giving results not very different from those 
arrived at by myself.^ He gives as the standard : 

Proteid. Fat Carbo-hydrate. Calories. 

For a man, no grams. 50 grams. 350 to 400 grams. 2,350. 
For a woman, 100 " 50 " 300 to 350 " 2,100. 

The following tables will serve as a summary of the points which I 
have attempted to illustrate. It is to be remarked that food prepared for 
the very sick should be nearly all digestible, while that for the well person 
contains at least 10 per cent, and more frequently 15 per cent, of indiges- 
tible material. 

xUeber die Kost in Kiankenhiiusem mit besonderer Berficksicfatigang der Miindiener VerhiUt- 
niase. Von Dr. W. PransnitZi Deutsche Viertdjahrschrift fUr offentliche Gesundheitspfl^e 1893. 
Band 25. Seite 563. 



l66 PROPHYLACTIC AND THERAPEUTIC VALUE OF FOOD. 
ESTIMATED LIFE RATION. 





Proteid, 
grams. 


Fat. 
grams. 


Carbo- 
hydrates} 
grams. 


Calories. 


For one day 


75 


40 


32s 







ESTIMATED WORK RATION, MAXIMUM AND MINIMUM. 





Proteid, 
grams. 


Fat. 
grams. 


Carbo- 

hydrates, 
grams. 


Calories. 


For one day. 


125 
no 


90 


450 
420 


3.S00 
3»ooo 





A COMMON INVALID RATION, TOO LOW IN CARBO-HYDRATES. 





Proteid, 
grams. 


Fat, 
grams. 


Carbo- 

hydrates, 

grams. 


Calories* 


One pint beef jnice, containing 7 per cent 

One pint whole milk 


3«S 
18.2 






129 
325-5 

397.9 


18.2 


22 

38 


One "quart flour gruel made with whole 




Two quarts of liquid. Total 


66.7 


Z^2 


60 


85M 



AN IDEAL RATION WITH SOLID FOOD. 



Material. 



Amount. 



O 



Proteid. 



O 



Fat. 



Carbo- 
hydrates. 



O 



I 



Bread 

Meat 

Oysters 

Breakfast Cocoa. . 

Milk 

Broth 

Sugar 

Butter 

Total 



226.80 

28.30 

113.40 

453.60 

28.30 

14.17 



16 
8 
8 

I 



31.75 

34-02 

12.52 

6.60 

3.63 

18.14 

0.X4 

106.80 



1.12 
1.20 

0.44 
a23 
ai3 
a64 



2.26 

11.34 
2.04 
7.50 

ii!i4 
12.27 
57.97 



ao8 
0.40 
ao7 
0.26 
ai6 
a64 



257.28 



0.60 
4.88 

90.7; 

27.36 



389.84 



9.04 



0.34 
ai7 
3.20 
0.96 



I,206l8» 

243.7a 
7aoi 
i3S4a 
7555 
613.21 
112.17 
118.62 

2,574.60 



PROPHYLACTIC AND THERAPEUTIC VALUE OF FOOD. l6j 
A COMMON INVALID RATION, TOO LOW IN PROTEID. 





Pioteid, 
grams. 


Fat, 
grams. 


Carbo- 

hydrates, 

grama. 


Calories. 


One pint beef broth or consomm^ 


2a5 


0.5 




88.7 
205.0 
521.7 

294.0 


One pint dried fruit soup. 


50 
79 

64 


One pint lemon whey 




21.5 
04 


One pint Imperial Granum, containing 
three ounces^ 


6.8 




Two quarts of li quid. Total 


27.3 


224 


193 


1.1094 



A RATION RICH IN PROTEID— AFTER ACUTE DISEASE. 



Matxaial. 


Amount, 
grams. 


Amount, 
ounces. 


Proteid, 
grams. 


Fat, 
grams. 


Carbo- 

hydrates, 
grams. 


Caknries. 


Bread 


453.^ 
453.^0 
453.60 

453.^ 

5^70 


16 
16 
16 

16 

2 


64.04 
29.02 

4.60 
0.14 


2.26 
22.68 
18.00 

3.25 
12.27 


257.28 


444.48 
iioioa 


Meat 


Coffee or tea with 


39.00 
1.14 




Suffar 


54.72 


224.35 














129.55 
12.95 


58.46 
5^ 


352.14 
35.21 


2,746.1a 
274.61 


Less 10 per cent, for 
indisestibility 






ua-MJQVs^.vuatj ..... 






Total 






116.60 


52.62 


316^3 


2.534.3» 









AN IDEAL RATION OF UQUID FOOD. 



Matxual. 


Amount 


Proteid, 
grams. 


Fat, 
grams. 


Carbo- 

hydrates, 

grams. 


Calories. 


Beef broth or consomm^ 


I pint 

20Z. 
I quart 

I quart 

3 0*. (dry) 

4 OS. (dry) 


20.5 
7.1 


0.5 
6.8 




88.70 

91.67 
410.00 

77.90 
651.00 
304.11 

42a25 


To which has been added one 

large egg, minus shell 

Dried fnutsouD 




100.0 
12.5 

^2 

100.0 


Lemon jelly 


6.S 

2.5 




Whole fniiltr .........!!..... 


36.0 
0.3 


Rice or arrowroot 


Grape sugar, or some one of 
the prepared foods (dry) .... 




Total 


2. c Quarts 96.0 


43.6 
» how the ri< 


323.7 
X is given. 


2Ai3-63 




to 
3.0 quarts,! 


^„ 



l68 PROPHYLACTIC AND THERAPEUTIC VALUE OF FOOD, 
A WORK RATION FOR A PROFESSIONAL OR LITERARY MAN. 



Material. 



Ounces. 



Proteid, 
grains. 



Fat. 
grams. 



Carbo- 
hydrates, 
grams. 



Calories. 



Bread.... 
Meat.... 
Butter . . . 
Sugar — 

Milk 

Oysters. . 

Seup 

Potatoes . 



Oatmeal 

Cream 

Fruit 

Additional liquid, tea, coffee, 
or water 



Total.. 



i6 
i6 

I 

\ 

4 

% 

3 

2 
I 

8 
30 



32.0 
50*0 



18.0 
7^ 
4.0 

3-0 

lao 

1.0 

0.5 



127.0 



3.0 

30.0 

25.0 


258 




no 
22 


18.0 
3.0 




38 


9.0 


4 

I 
SO 




96.0 


483 



1,2x6.6 

48ix> 

230.0 

451.0 

329.6 

37-8 

44^ 

168.1 

123.8 

25.1 

70.1 

207.1 



3.384.2 



XXXII. 
MUNICIPAL HYGIENE AND SANITATION. 

By E. S. KELLY, M. D., 

Commissioner of Health, 

Minneapolis, Minn, 

Gentlemen : During the year 1889, our state legislature passed a spe- 
cial act relating to the reorganization of the health department and the 
preservation of the public health of the city of Minneapolis. The act pro- 
vided for the establishment of an executive department in the municipal 
government of the city of Minneapolis, to be known as the Department 
of Health, embracing the mayor, committee of the city council on health 
and hospitals, the health commissioner, medical inspectors, meat, bread, 
and sanitary inspectors, besides superintendent of quarantine hospital, 
clerks, and dump men. Ample authority was granted for quarantining 
all contagious diseases, disinfection of houses, powers and privileges of 
health inspectors, vaccination of school children and others, and for com- 
pelling physicians to report births, deaths, and contagious diseases within 
a specified time. 

The working force employed since October i, 1892, consists of 3 med- 
ical inspectors, 7 sanitary inspectors, 2 meat inspectors, i bread inspec- 
tor, I special inspector for glandered horses, superintendent quarantine 
hospital and matron, 2 clerks, and i dump keeper. 

The total number of contagious and infectious diseases reported during 
the year was 2,065 — measles, 211; diphtheria, 268; scarlet-fever, 649. 
With the following mortality: Measles, 7; diphtheria, 59; scarlet-fever, 
38 ; and enteric fever, 118 ; — making the total mortality 222. 

There were quarantine and disinfection in all cases except enteric fever, 
where we disinfected discharges and fumigated on general principles. 

There were 28 horses quarantined, and 22, being found glandered, 
were killed. Mallein has been used frequently to aid in the diagnosis, 
with marked advantage. 

Our garbage is collected at one central dump, and put on board cars 
specially constructed for its removal to the farming districts for fertilizing 
purposes. The average is ten car-loads each day. This material con- 
sists of all kinds of refuse matter, night soil excepted. This system is 
quite expensive, the contractor receiving $17,000 a year direct from the 
city, and about $1,200 each month in dump fees, charged for the privi- 
lege of dumping. The latter is collected from the producer, — so much 
per load or barrel. This system is one step toward the solution of the 



170 MUNICIPAL HYGIENE AND SANITATION 

disposition of garbage in cities generally. Theoretically it is good, return- 
ing the material which plant life has taken from the soil ; but practically 
it is too expensive. The final disposition of all city waste refuse and 
kitchen garbage should be cremation ; and as soon as the present con- 
tract expires, I hope to see crematories established in place of the rail- 
road transportation at present in force. 

Our city embraces within its corporate limits 50 square miles, and has 
a population of 225,000 people, 38,000 houses, 100 miles of sewers, and 
100 miles of water mains. Four thousand five hundred houses have 
sewer and water connections; 10,000 houses have water connections 
without sewers. Twenty-eight thousand houses depend upon well-water 
for drinking and culinary purposes ; and have privy vaults of various 
nondescript character, from a hole in the ground to commodious, properly- 
constructed vaults for the reception of night soil. The cesspool, like the 
<<all-seeing eye," is ever present, — ^the angel of death and special sUent 
friend of the funeral director. In my opinion, the cesspool is the most 
fruitful source of diphtheria, and ought to be abolished in every muni- 
cipality. 

Twenty-eight thousand houses without sewer connections and city 
water-supply, may seem an appalling state of municipal affairs to the 
modem sanitarian. But in this case, we have a city without a parallel in 
the history of the world ; 225,000 English speaking people domiciled in 
38,000 houses, the result of a quarter of a century's growth and enter- 
prise. To construct a network of sewers and water mains, covering the 
50 square miles within our corporate limits, would cost millions of dollars 
alone, but when we add to this the vast sums required for paving, curbs 
and gutters, sidewalks, public buildings, and current expenses, we feel 
that such a condition is not abnormal, and all that we can require is a 
few years more of our usual prosperity and this gigantic sanitary work 
will be equal to any of our older cities, giving sewer and water to every 
cottage within our city, abolishing every cesspool and privy vault. 

No language which I might use could be half as convincing as the 
vital statistical record for Minneapolis during the past 10 years. In 
1883 our annual death rate per 1,000 was 25.3; in 1884, 20.0; 1885^ 
17.9; 1886, 15.0; 1887, 17.0; 1888, 15.0; 1889, 13.4; 1890,12.7; 1891^ 
10.4; 1892, 10.8; and in 1893, 9.59. This result has been attained by 
faithftd and efficient sanitary work, and we propose to continue as vigilant 
in the future as we have been in the past, and hold the pennant for the 
healthiest city in the world. 

Our department received information from Charles N. Hewitt, M. D., 
secretary of the state board of health, of all the immigrants arriving in New 
York and Canada, destined for Minneapolis, so that our special immigrant 
inspector has ample notice before their arrival. When they do arrive, 
we take their name, street, and number, and observe them for several 
days. By this eternal vigilance our city remains the cleanest, is the most 
prosperous, and has the lowest death rate of any city in the world. 



MUNICIPAL HYGIENE AND SANITATION 171 

The question may be asked, to what special causes do we attribute 
our remarkably low death rate. In my opinion, it is the result of many 
causes. Probably the first is the general good sanitary condition of our 
city; second, thousands of our people came from Norway, Sweden, Ger- 
^aiojiyy England, Scotland, Ireland, Canada, New England, and Middle 
States. The average age would not exceed twenty-five years. Past the 
dangers of childhood, they ought to have at least twenty-five or thirty 
years of comparative freedom from any form of disease. 

Our water-supply is taken from the Mississippi river above any point 
of possible contamination from city sewerage or garbage. Our pumping 
capacity — 71,000,000 gallons per day — insures an abundance of water 
for every purpose. 



XXXIII. 

THE PROGRESS OF SANITARY KNOWLEDGE AMONG THE 
WOMEN OF ENGLAND. 

By Lady PRIESTLEY, 

Vicb-Prksident of the National Health Society, Representative of Hygiene 
ON THE Woman's Committee of the Chicago Exhibition, 

Ltmdon, Eng. 

Having had the honor to be asked by the committee to contribute a 
short paper to this important section of the World's Congress Auxiliary 
of the World's Columbian Exposition, I think I cannot do better than tell 
the women of the United States how the women of England came to take 
a practical interest in domestic sanitation. 

Those engaged in the subject professionally will be able to give you 
the benefit of their experiences, and no doubt valuable statistics showing 
the influence of improved house sanitation on health, and the decrease of 
mortality which has followed. 

In giving my own experiences we must go back twenty years, to the 
time when I joined the executive committee of the National Health 
Society and attended the meetings in a small, dingy, drafty room in a 
house about as unsanitary as any to be found in London. Our committee 
was composed of some three or four women profoundly ignorant, who 
were willing to learn, and some half-dozen men at the head of sanitary 
affairs, who were willing to teach. Having this opportunity of hearing 
practical matters discussed, the women of the committee became, first, 
deeply impressed with the necessity of sanitary reform, and secondly, 
possessed with a conscientious desire to spread to others the knowledge 
they themselves were thus acquiring. 

Under such masters as Sir Robert Rawlinson and Sir Edwin Chadwick, 
they recognized the connection between sanitary engineering, the water- 
supply, and the death rates, and, applying the principles to themselves, 
soon became aware that their homes were not models of the sanitation 
they desired. Arrangements which had been perfectly satisfactory in the 
dark days of ignorance, could no longer be tolerated in these days of 
hygienic dawn. Taking a retrospect of their own family histories, they 
could trace many a death to a preventable cause, and they saw now, for 
the first time, how greatly the perils of child-birth were increased or 
diminished by surroundings. In their homes they had only to look 
around to find the "lurking principles of death" everywhere. The 



PROGRESS OF SANITAR Y KNO WLEDGE IN ENGLAND, 1 73 

luxuriously fixed bath and wash basin were simply means of bringing 
sewer gas straight into the bed-rooms, the overflow pipe of the cistern, 
whence the drinking water came, was directly connected with the soil 
pipe. The house drain brought the house into direct communication with 
the street sewer, and afforded it the only means of ventilation. In a word, 
the walls and floors, which had so long remained dumb to the uninitiated, 
now became eloquent, and could no longer conceal the dark secrets which 
had so important a bearing on health, and which they were now deter- 
mined to fathom. From the cisterns, stowed away in impossible places 
in the attics, to the " ramified seething world of disease " under the base- 
ment, domestic reform set in, and served as an example to various little 
family circles, where the word was passed round. It was thus the seed 
of practical knowledge was first sown by women among women, but the 
early pioneers, like the early Christian martyrs, had no small opposition 
to encounter, and were said to have '' drains on the brain." 

Meanwhile, the National Health Society was doing effectual work in 
pressing the subject on the notice of the upper classes, by giving drawing- 
room lectures. These lectures became so popular, and went so thoroughly 
to the root of matters, that in time no one thought it at all extraordinary, 
to find a fashionable drawing-room in Mayfair converted into something 
very much resembling a plumber's shop ; the floor covered with pipes and 
traps of every sort, and with a royal princess and suite taking the deepest 
interest in the whole thing. 

In 1884, an immense impetus was given to the subject through the 
health exhibition in South Kensington. Here, everything sanitary and 
insanitary, was exhibited side by side. One of our lady pioneers got a 
certificate for exhibiting a beautiful floral ventilator she devised for the 
boudoir, and she was also an exhibitor of various other useful things. 
Perhaps the thing which impressed the mind most, and did the most to 
teach through the eye, was the villa wherein everything was strictly right, 
from beginning to end. It stood side by side with a precisely similar 
villa (the villa alas, of the period!) wherein nothing was right from 
beginning to end. These villas were built as models by one of the experts 
of the executive committee, and illustrated very graphically the evils he 
found every day in the course of his professional career, as an architect 
and sanitary engineer. It was deplorable to think that the first house in 
London, which was ever known to be built right from the beginning, 
never had a tenant 1 

Up to this time, the literature on the subject was scanty, and of too 
technical a nature to become generally popular, but now the ladies of the 
National Health Society took to writing their own experiences, and 
issuing leaflets and pamphlets suitable for all classes. The book that 
did more to instruct than any other, was Mr. Pridgen Teale's " Dangers 
of Health." It illustrated every possible danger. Little blue arrows 
were made to follow the course of the sewer gas through chinks in the 
floors, and even through key holes, until they reached the sleeping 



1 74 PROGRESS OF SANITAR Y KNO WLEDGE IN ENGLAND, 

inmates, or pointed directly to the baby in the cradle. This had such a 
terrifying effect on the maternal mind, that inquiries were immediately 
instituted, and things wrong were set right. Her Royal Highness, the 
Princess Christian of Schleswig Holstein, translated the letter press of 
this book into German, and it is now to be found in various languages, 
in many drawing-rooms throughout Europe. 

As an instance of a lady being her own sanitary engineer, I shall briefly 
mention the case of a member of the committee, whose husband had 
taken a shooting lodge in Scotland. The house drains were found to be 
composed of papier mach^, which had become rotten and lay collapsed 
under ground. The matter was placed in the hands of a plumber, who 
was said to understand his business, and to whom particular directions 
were given respecting modem principles. There was no teaching this 
man, for he knew everything; nevertheless, this lady resolved to test 
matters for herself before the arrival of the family. Needless to say, 
in a remote country place, the system was that of cesspools, but they 
need not, necessarily, be dangerous to health. All these places had been 
thoroughly cleansed before her arrival, so that inspection and personal 
superintendence did not involve anything unpleasant 

The place consisted of a large dwelling-house, the drainage of \diich 
was carried to an old mill, which had to do duty as a cesspool. Further 
was a group of cottages and laundry, and beyond, stables and kennels, 
the drainage of which was conducted to cesspools in the fields. 

Having directed the servants in the house to turn on the water full, she 
stationed herself at the mill to see if it came in freely, and found that it 
only trickled in through a chink in the wall, and not through the legiti- 
mate channel at all. She therefore got some men to open the ground 
outside the wall where the drain was supposed to pass throu^, and found 
the new earthenware pipe lying broken and useless. Instead of allowing 
the men to replace it with another earthenware tube, as they suggested, 
she took the opportunity of acting up to modem principles by disconnect- 
ing the house entirely from the impurities of the termination. Seeing a 
piece of lead l3ring near, she made the men take this and form it into an 
open gutter, as a channel of communication between the drain and the 
old mill; thus securing an intervening space of fresh air. When the 
ground was duly prepared for this new arrangement and the work made 
good, the test was again applied, and was found to answer admirably. 

This completed, she adjourned to the field, and found the second cess- 
pool carefully battened down under a slab of slate, which she inunediately 
caused to be removed. The overflow pipe was discovered to be above 
the level of the inflow, which meant the contents surging bade to the 
house and having no outflow whatever. Now this lady had never don6 
such work before, neither had she ever seen such a place before, but with 
a trained sense of responsibility, and some knowledge of fundamental 
principles, she simply depended on reasoning the matter out. In diis 
case she quickly reasoned that the only ventilation to the pent up sewer- 



PROGRESS OF SANITAR Y KNOWLEDGE IN ENGLAND. 175 

gas was into the bed-rooms at the other end ; therefore she determined to 
open the ground for three or four feet and leave an open communication 
with the cesspool, as she had previously done with the other, and after 
lowering the overflow pipe she felt, that however crude the work might be, 
she had, at all events, averted the troubles which the plumber had care- 
fully prepared for her family. 

In the third case the same evils were found and the same remedies 
applied. 

A few years later, when making her usual inspection, she found that 
the drain of the large house was blocked with the roots of trees, which 
revealed the fact that the plumber had joined the earthenware tubes with 
clay instead of cement. She now had the whole thing renewed under her 
own supervision, and placed on the most approved principles of modern 
science. This served as a model for other lodges in the neighborhood, 
and so the good seed was spread. 

I would impress on all mothers, and those who are responsible for the 
welfare of others, the desirability of giving ungrudgingly the personal 
care and forethought which alone can avert the consequences of the evils 
I have mentioned. The remedy, as a rule, is very simple. A little atten- 
tion to the subject, and intelligence quickened with a sense of danger to 
those we love, are often sufficient to meet the want of great technical 
knowledge. 

So much has the importance of this subject been appreciated by the 
women of England of late years, that the National Health Society is no 
longer stowed away in a dark and dingy comer. It has burst into the 
light of day as a most influential body, composed largely of women, and 
patronized by the highest people of the land, all working together for the 
same end, which is best expressed in the motto of the society, '' Preven- 
tion is better than cure." 



XXXV. 

HOW CAN WOMEN BEST PROMOTE PUBLIC SANITATION? 

By SARAH H. BRAYTON, M. D., 

Chairman of the Woman's Public Health Committee of the Congress 

Auxiliary. 

Lady Priestly, vice-president of the National Health Society of England, 
has favored us with a paper on this subject. Before presenting it I will 
briefly outline the scheme of work of the organization which brings to its 
service so many influential women, and ask if we might not hope, as an 
outgrowth of this congress, to establish something after the same order, 
perhaps in connection with municipal order leagues, university extension, 
and college settlements. 

In 1857 the Ladies' Sanitary Association was organized in London, for 
the diffusion of sanitary knowledge and the promotion of sanitary reform 
among all classes, but the work being of national importance, it soon out- 
grew the limited boundaries of this organization, and the National Health 
Society was formed on a larger scale, with the same purposes in view. 

This association organizes lecture courses, to be given not only in the 
society's rooms but everywhere, from the drawing-rooms of a princess 
royal to the hovels of the poor in cities, out into the homes of cottagers 
and farmers in the rural districts. 

These lectures include courses on the laws of health, personal and 
domestic hygiene, household sanitation, cookery, first aid to the injured, 
and nursing. 

The first course of lectures on nursing was given at the instance of 
that well known cosmopolitan philanthropist. Lady Henry Somerset. 

The Baroness Burdett-Coutts also organized and maintains lecture 
courses among the very poor, on subjects best calculated to uplift them 
physically as well as morally. 

In addition to instances of this kind, much valuable work is accom- 
plished by volunteers. 

One of these teachers, an earnest and gifted woman, told me she gave 
a series of talks in the Whitechapel district. We all know the reputation 
of the place for squalid poverty, not to mention its vice, but even here 
women were ready to listen to women, and the attendance increased at 
each meeting until over two hundred were present, and on one occasion 
the lecturer counted sixty women who remained after the session to ask 
questions, proving themselves not only attentive listeners but eager to 



HOW CAN WOMEN PROMOTE PUBLIC SANITATION? 179 

carry out suggestions that tended in any practical way to ameliorate their 
wretched condition. Their minds were awakened to the reception of 
hygienic truths, and when the sanitary inspector passed their way he met 
with a civility that surprised him. He was welcomed as a benefactor 
where before he had been treated as an invader of private rights. In 
place of active opposition he found willing cooperation. 

When the tenant, however ignorant, can be taught the importance of 
sanitation, and the best methods for carrying out its simplest rules, the 
delinquencies of the landlord should be met with some stringent munici- 
pal law if the more humane sanitary laws do not suflficiently appeal to 
him ; otherwise there cannot be any great advance made in public health 
movements. 

The Sanitary Institute of London is also doing a work worthy of our 
imitation. The object is to promote the advancement of sanitary science 
in all its branches. Examinations are held, and, as at present arranged, 
are adapted for surveyors and sanitary inspectors. 

The first woman who sought admission to this scientific school had 
many obstacles to surmount before she was granted the privilege of 
matriculation. She passed most creditably the practical examinations of 
th^ institute, including those in drainage and kindred subjects, thus quali- 
fying herself as a sanitary inspector. After graduating, she was enrolled 
as an associate member of the Sanitary Institute. 

At the present time our most efficient workers in preventive medicine 
and sanitation are the trained nurses of the country, especially the visit- 
ing or district nurses. They are directly and indirectly doing excellent 
work in the practical teaching of domestic hygiene wherever they go, and 
this applies to their influence in the homes of the rich as well as the poor. 

The object lessons taught by the trained nurse are naturally more con- 
vincing than all the lectures and arguments that can be given, and in 
view of the great field of sanitary work confronting her, I would suggest 
to the officers of nurses' training-schools that courses in sanitary science 
be incorporated in the curricula. 

Trained nurses invariably possess the confidence of the people among 
whom they labor, and, as a rule, an eager interest is manifested in follow- 
ing their skilled methods of work. As instructors in hygiene, nurses have 
a wider scope for sanitary reform than physicians : living as they do with 
the families they attend, their opportunity for the diffusion of luiowledge 
is greater. 

In seeking to have women widely instructed in sanitation, domestic as 
well as public, and in order not to fall in with the tendency of the age 
toward over-multiplication of organizations, I would suggest that, as far 
as possible, existing societies be made use of, wherever they are found in 
operation along analogous lines, to give the rudiments of the science at 
least. 

All schools and colleges should, of course, make provision for such 
instruction for both boys and girls, and for the large adult class. Univer- 



l8o HOIV CAN WOMEN PROMOTE PUBLIC SANITATION! 

sity extension, with its numerous branches and far reaching influence, is 
a capital medium for the dissemination of such knowledge. Municipal 
order leagues, college settlements, and nurses' training-schools also fur- 
nish excellent channels through which to impart these great truths, and 
these courses could still be tributary to the more distinctive high school 
of the science, the sanitary institute, or national health society, when the 
time comes for their organization. 

Clearly there is work waiting for women to do. Great advance has 
been made, in the last decade even, in their education ; but physiology 
and hygiene still remain the most important and the most neglected of 
all studies, and that too, notwithstanding their principles are peculiarly 
adapted for those having the immediate care of the family and the 
home. 

When we think of the terrible sacrifice of life from preventable causes, 
especially infant life, who can estimate the power for good that women 
may become when properly qualified by careful, comprehensive instruc- 
tion in the laws of health ? 

They have responsibilities which are theirs by right — ^theirs only — 
which they cannot shirk, and that no one has the right in any way to cur- 
tail. 

Being responsible for such vast health interests, they must be fitted to 
bear creditably the honors of their position. All must realize that they 
have a share in the maintenance of the health of a community and can 
best promote it by a thorough understanding of practical domestic san- 
itation. 

" Looking well to the ways of her household " may be a little thread- 
bare, but it verifies that other good old proverb, that " Prevention is bet- 
ter than cure." 

When the laws of hygiene are sufficiently respected, there will be small 
need of the expensive machinery of quarantine stations and such public 
protective measures. 

When women qualify as inspectors, and are engaged to look after 
schools, factories, shops, and tenements where women and children con- 
gregate, we hope for greater immunity from diseases due to overcrowding, 
defective ventilation, and other unsanitary conditions which seem so 
constantly to escape the attention of men. 

It is not unreasonable to hope that, as architects, women may distin- 
guish themselves by effecting something more definite and reliable in the 
way of ventilation and house drainage. From the absence of any ade- 
quate provision for the former in most of our houses, and especially in 
public assembly rooms, one would suppose that the principle is either too 
subtle, or else the subject has been wilfully ignored. 

There is doubtless much that women could do on health boards, but 
there is more that they must do among their own sex, especially to 
increase the sum of sanitary knowledge and promote intelligent coopera- 
tion with health authorities whoever they may be. 



IfOlV CAN WOMEN PROMOTE PUBLIC SANITATION? l8l 

In this great cause, the " greatest good for the greatest number " can 
only be achieved through the cooperation of earnest men and women. 
The most distinguished sanitarians will find their best efforts futile with- 
out it : with it one of the noblest reforms of the age can be carried to 
success. 



XXXVL 

BRIEF NOTICE OF THE CLIMATE AND DISEASES OF 

BRAZIL, ESPECIALLY OF THE CITY OF 

RIO DE JANEIRO. 

By Dr. JULIO BRANDAO, 
Rio de Janeiro^ 

I. CLIMATOLOGY. 

The climate of Brazil, said the savant, Dr. Sigaud, is considered, with 
just reason, the most beautiful and the healthiest of all the regions of the 
world, and is to the American continent, south and north, what Italy is to 
Europe. 

Brazil belongs to the austral hemisphere, and b situated between 
4° 20' latitude north and 33° 55' latitude south, having many lakes, rivers, 
and mountains ; the ocean and large rivers are its boundary lines ; it has 
the best system of natural irrigation, and presents, in its vast extension of 
territory, the most enviable climate, whose essential element is the tropical 
heat. The opinion of many scientific men, notably Humboldt, who have 
studied the climatology of Brazil, is that its temperature depends upon 
the situation and nature of the places. The temperature on the coast, 
allayed by the sea and its breezes, is fresh and much different from the 
regions situated under the same parallel but out of the way of the cur- 
rents. Finally, the temperature there determines, in its rising and falling 
courses, two principal seasons or periods of the year. The mean tem- 
perature of Rio de Janeiro, is 22° to 23° Centigrade (about 70° F.), the 
maximum 34° to 35° Centigrade, and the minimum 12° Centigrade, 
The hottest months, which constitute principally the summer, are Jan- 
uary, February, and March ; and the coolest are June, July, and August. 
The sky is always of a charming purity. The rainy season, in Rio 
de Janeiro, also in the whole oriental coast of Brazil, begins usually 
in the months of October and November, and sometimes extends until 
April, having in January the heaviest rains. Great irregularity, however, 
happens in this general distribution. The storms are now quite rare in 
Rio de Janeiro, but sometimes very severe. The prevailing winds are, as 
a rule, from north to south, and constitute the cool breezes ; but the 
big storms are always followed by winds from the south or south-west. 

II. MEDICAL GEOGRAPHY. 

A, — Food^ Alimentation^ Regimen^ Acclitnatation. 

The city of Rio de Janeiro offers at present all the comfort and advan- 
tages of the European and North American capitals. The French cook- 



THE CLIMATE AND DISEASES OF BRAZIL, 183 

ing predominates over the English and German, and even over the Portu- 
guese. The Bahia style of cooking is, to a certain extent, the national 
cooking, in which we find the Vatapd (Vat-tah-pah), the Carir& (Cah-ree- 
roo), and other dishes prepared with oil of dendk (dan-day), red pepper, 
cocoanut juice, or milk, etc. ; — it is a stimulant cooking par excellence. The 
price of provisions for daily consumption has greatly increased in Rio de 
Janeiro, but, on the other hand, they are abundant and of a very superior 
quality ; they are beef, pork, mutton, vegetables, bread, milk, etc. The 
markets are well supplied with fruits, greens, and an abundance of fish 
and moUusks ; and in this particular case, Rio de Janeiro has no equal, 
for nowhere are the fish so plentiful, tasteful, and of so many varieties. 
In the interior, mainly in the south, the principal alimentation is the 
black bean, pork, jerked beef, mutton, goat flesh — ^in many places the 
Indian com replaces the manioc; vegetables, principally the cabbage, 
are in daily use ; the game, fish of rivers, and fruits of delicate flavor, are 
plentiful in the public markets. The variety and style of the bill of fare 
are such as not to give cause to envy those of the other civilized countries 
of the world. As usual the drinks are milk, coffee, tea, and matte (mah- 
te), of which the use is soipetimes very immoderate and excessive. The 
drinking water is of the purest kind, and flows from innumerable springs, 
the water-supply of the capital being one of the most admirable works of 
modern engineering, executed by Brazilian engineers. The water runs 
through pipes at a great pressure, and can afford to each inhabitant of 
the city, from two hundred to three hundred litres daily, and reaches the 
highest buildings. 

The use of alcoholic drinks is very moderate, except among the low 
class of people, where its use has caused an increase in mortality in gen- 
eral. It is by following the alimentary regimen that we can establish the 
most important condition of enlarging the term of our life, and of the ac- 
climatation. The acclimatation observances in Brazil, must apply to 
Americans and Europeans as well as to Brazilians who change from one 
to another state. All are affected, and suffer a modification, either 
quickly or slowly, by the influence of the air, water, place, regimen, and 
profession they practise. 

The acclimatation in Rio de Janeiro, as in every tropical region, re- 
quires from two to three years of time to enable the immigrant to stand it 
without being affected in his health by the effects of the heat, of the ali- 
mentary regimen, and the style of living in such latitude. 

Inside the limits of the city of Rio de Janeiro, and at a short dis- 
tance from its centre, we find desirable regions offering all imaginable 
comforts. The climate is healthy and cool in the summer, as, 
for instance, — Tijuca (Tee-joo-cah), tJie hill of St. Theresa, and the high 
plateau of Larangeiras (Lah-ran-jai-ras) ; the Corcovado (Kor-ko-vah-do) 
at 700 metres (about 2,200 feet) above sea level. All these resorts are 
very popular during the summer, and sought as the healthiest and coolest 
surroundings of Rio de Janeiro, owing to their altitude, the purity of their 



184 THE CLIMATE AND DISEASES OF BRAZIL. 

waters, and wildness of their woods affording the enjo)anent of a fresh 
breeze and the perfume of the native vegetation. 

The picturesque city of Petropolis, at 900 metres (about 2,700 feet) 
above sea level, is easily reached from Rio. It is a select summer city 
for the wealthy population of the capital. 

The acclimatation in Brazil is an easy think to be accomplished ; the 
heat of the littoral is abated by the cool breezes of the ocean. The 
southern states offer, above all, the most agreeable and desirable tem- 
perature of the universe : it is the temperate climate of Italy during the 
whole year ! Acclimatation in the central and southern states of the 
republic is easy, and Americans and Europeans must not fear any 
danger or discomfort. Very many immigrants from those countries 
have established their homes in the states of Meinas (Mee-nas), St 
Paulo (St. Paul), Bahia, Rio Grande de Sul, etc., and the success of 
these enterprises is a very significant proof of the healthfulness of the 
climate of Brazil. 

B.— Pathology, 

The inter-tropical pathology comprises with preference the pyreocis, I 
shall speak here only of those of a zymotic nature, on account of their gravity 
and frequent occurrence ; for the other diseases of the nosologic list are 
uncommon and unimportant in Brazil in comparison with other countries 
of Europe and America. 

I beg to mention the opinion of Dr. Aureliano Portugal, the illustrious 
Brazilian demographic doctor of medicine, and as much as possible I will 
abridge what he said. 

Of all the endemo-epidemic diseases of Rio de Janeiro, the yellow-fever 
has the first place in the classification, not only because, next to tu- 
berculosis, it is the one which shows more deaths in the last forty years, 
but also because it has been the exclusive cause of the unjust reputation 
of an unhealthy and insalubrious character which the capital of Brazil has 
in foreign countries. 

The yellow-fever was first brought, in December of 1849, into the city of 
Rio de Janeiro, from the city of San Salvador (Bahia), where it prevailed 
from December of 1849, there being imported directly from New Orleans. 
It became epidemic in Rio de Janeiro in February of 1850, to decline in 
May, and disappear entirely in June of 1863. From 1864 until 1867 not 
one case of death took place by yellow-fever. In 1868 it was imported 
again, and then became endemical in Rio de Janeiro, producing great de- 
vastation during the warm season, mainly in the months from January 
to March. The statistics show, however, that while the population of Rio 
de Janeiro having increased in proportion of four to one, in said period, the 
deaths by that disease, notwithstanding, have proportionately diminished 
every year, due surely to the measures taken by the general board of 
public health of the Federal capital. These facts show, without giving 
reason for doubt, that the many hygienical improvements now put in 



THE CLIMATE AND DISEASES OF BRAZIL, 185 

practice — viz., draining the soil, re-construction of the sewer system of the 
city, and the continuation, on a large scale, of the inoculations of the 
attenuated cultures of the microbe of yellow-fever, according to the 
method of the savant Dr. Domingos Freire, of Rio de Janeiro, and other 
innovations — have already done much and will be sufficient, finally, to 
exterminate the germs of yellow-fever in Rio de Janeiro, requiring only 
the attention of the hygienical body, hereafter, to prevent the re-intro- 
duction, as it took place in 1868. 

Next to the yellow-fever comes the malaria, which is the disease to 
which the inter-tropical region owes its unhealthy condition. As is 
known, malaria and tuberculosis have contributed to the largest num- 
ber of fatal cases in the mortality of Rio de Janeiro, being, among the 
zymotic diseases, the two more constant causes. It is not safe to say 
that malaria has increased in Rio de Janeiro, for the annual mortality in- 
creases in proportion to the increase in population. 

We see by the statistics, that the native population is the most victim- 
ized by the malaria, in the proportion of 65 per cent., — ^those of foreign 
birth being represented by only 35 per cent. — of the mortality. This une- 
qual proportion proves that the continuance in a malarial region, and the 
fact of having endured one or more attacks, increase the receptivity^ 
while with the yellow-fever it is exactly the contrary, for a first attack pre- 
vents future ones, since the person remains in the same place. 

The months during which the malaria increases, and becomes more 
dangerous, are January, February, and, particularly, March. The hy- 
gienical arrangements which will soon be made to prevent the yellow- 
fever, will also contribute surely to diminish or extinguish completely the 
malarial germs in the capital of Brazil. 

After the yellow-fever and the malaria, the small-pox is the most terri- 
ble and disturbing element which contributes to the mortality of Rio de 
Janeiro. But it can be stated safely that its effects have been greatly 
checked by vaccination on large scale, such as has been carried on in Rio 
de Janeiro; and with the recent law for compulsory vaccination and 
other laws for the same effect established by the sanitary police, this terri- 
ble calamity will disappear, as it did in Germany and other European 
countries, where vaccination is compulsory. 

This is, in brief, ladies and gentlemen, the horrible phantom which 
causes so many apprehensions and fears to foreigners. 

Before coming to a close, I beg to mention that in submitting to you 
this sketch, I had in view only to comply with the honor of the invitation 
extended to me by this learned and distinguished body. I also feel grati- 
fied to have had an opportunity to refute the false and unjust rumors about 
the city of Rio de Janeiro which circulate in foreign countries, in detri- 
ment of the good name of my country. If I have succeeded, your ver- 
dict will be my reward. 



XXXVII. 
IMPORTANCE OF CIVIL PUBLIC HYGIENE TO THE STATE. 

By Sir CHARLES A. CAMERON, 

Ex-President and Professor of Hygiene and Chemistry Royal College of 
Surgeons, Ireland, Chief Medical Officer of Health for Dublin. 

Among the characteristics of the nineteenth century, there are none 
more remarkable or more important than the immense growth of the towns. 
In many parts of Europe the rural population has remained stationary, and in 
others it has declined, and this has occiured even in some parts of the new 
world, but almost everywhere in the civilized parts of the globe, there has 
been an increase in the population of towns greatly exceeding that which 
has occurred in any previous century. In 1801, the population of England 
and Wales was 8,892,536, while in the middle of 1893 it numbered 
29,729,506, or nearly three and one-half times greater. In 1801, the 
population of London was 958,863 : now it amounts to nearly four and 
one half millions. The population of " greater London " was estimated 
on the 30th of June to be 5,849,104. In the same period the population 
of Liverpool increased from 78,000 to 501,486, and that of the parish of 
Manchester, which contains a cluster of towns, from 112,300 to about 
800,000. From 1801 to 189 1, Scotland increased from 1,608,420 to 
4,025,647, but the population of the largest town, Glasgow, increased 
within the same period from 77,385 to 677,883. In Ireland, the popula- 
tion is less now than it was at the beginning of the century, while the popu- 
lation of its capital, Dublin, has been more than doubled, and the popula- 
tion of the chief commercial and manufacturing city, Belfast, has increased 
from 37,277 in 182 1, to 255,924 in 1893. In the last century the great 
majority of the English people lived in the rural districts : now two out of 
every three reside in towns. In English counties which contain few 
large towns, the tendency is towards decay of population. For example, 
the people of Lancashire, which is full of towns, increased from 3,454,438 
in 188 1 to 3,926,798 in 1891 — that is, in ten years 472,360 souls were 
added to the population. There are one hundred towns in England with 
a population over 33,000, making a total of 14,142,127. On the other 
hand, the agricultural county of Salop lost in the same period five per 
cent, of its inhabitants. On the continent of Europe the development of 
towns, though not so marked as in England and the United States, is still 
very striking. During the present century the population of France has 
not increased fifty per cent, while that of Paris has gone up from 



IMPORTANCE OF CIVIL PUBLIC HYGIENE. 187 

580,000 in 1808, to 2,424,705 in 1893. In Berlin there were only 
250,000 persons in 1832, but now its inhabitants number 1,714,938. In 
1850, New York had a population of 515,547, which has since increased 
nearly four fold. As for Chicago, its growth is unequalled in either 
ancient or modem times. Fifty-three years ago it was a village with 
5,000 people : now its population exceeds a million and a half. Every 
year nearly 300,000 are added to the English towns, and a half million to 
those in Germany. 

The duration of human life is much shorter in towns than in rural 
districts ; we might, therefore, expect to find the death rate of a country 
increasing proportionately to the preponderance of its urban over its 
rural population. In England, however, the death rate has been declin- 
ing notwithstanding the increase of town population, which is a proof of 
the great improvements which have been effected in urban sanitation. 
But much as has been done to lessen the evils incidental to town life, 
vast is the work still unaccomplished. The death rate in the twenty- 
eight largest English towns is still five per one thousand persons living in 
excess of the rate in the rest of the country. In some towns the death 
rate is more than fifty per cent, greater than it is in the rural districts. 
It must be borne in mind in comparing the bills of mortality of the towns 
with those of the open country with respect to age and sex, that the popula- 
tion of the former are placed under more favorable conditions than are the 
rural population. Females live longer than males, and their proportion 
of the population is greater in the towns. Persons whose " expectation 
of life" is greatest are more numerous in the towns than in the 
country. The death rates in towns must, therefore, be corrected by what 
vital statisticians term the "distribution of age and sex." The mean 
crude death rate of the twenty-eight largest towns of England in the 
decade ended in 1890 was 21.35 P^'^ o^^ thousand persons living, while 
in the rest of the country it was 18.19 ; corrected, however, for age and 
sex distribution the town death rate was 22.75, ^^^ ^^ ''^^^ ^"^ ^^ ^^st 
of England 17.79. Although Plymouth with a recorded death rate of 
21.4 appeared to be in a worse sanitary condition than Cardiff, with a 
rate of 20.7, yet the rates corrected show that the real one for Plymouth 
was 21.2 and for Cardiff 22.5. In comparing the death rates of coun- 
tries, no allowance is made in favor of those in which the urban popula- 
tion exceeds the riural. If such an allowance were made in comparing 
England with foreign countries, its sanitary condition would appear even 
more favorable than its recorded death rate would seem to indicate. 

It is a melancholy reflection that the duration of a life is, on the aver- 
age, much shorter in town than in the country. The causes are pretty 
well known. Some of them are as follows : Too close an approximation 
of people, /. ^., too great density of population ; want of proper main 
drainage ; imperfect sanitary accommodations in houses ; defective house 
drains ; storage of filth ; dampness of soils and sub-soils ; want of abun- 
dance of pure water ; unsoundness and adulteration of food ; presence of 



l88 IMPORTANCE OF CIVIL PUBLIC HYGIENE, 

slaughter houses and dairy yards ; trade nuisances of various kinds ; 
unsuitable tenemental dwellings ; over-crowding of the homes of the 
poor ; spreading of infectious diseases — ^the result of want of notification 
of them to the sanitary authorities, and of the non-isolation of the 
patients ; imperfect disinfection, or no disinfection, in the case of infected 
clothing, bedding, and dwellings. All these unsanitary evils admit of 
removal or mitigation ; and in many towns much has been done in this 
direction, though vast is the work still to be accomplished. The dwel- 
lings of the working classes have been much improved and from many 
towns filth is now rapidly and completely removed. In Dublin, during 
the last twelve years, more than two thousand unhealthy dwellings have 
been de-tenanted and closed by magistrates' orders at the suit of the sani- 
tary authority. 

The powers entrusted to municipal authorities in Great Britain and 
Ireland are in relation to health matters of the most extensive character, 
and their application is practically limited only by the element of expense. 
Every species of nuisance may be dealt with. They can provide pure 
water, establish public abattoirs, acquire and lay out land for the pleasure 
and recreation of the citizens. They are enabled to build dwellings for 
laborers and artisans, and to maintain nightly lodging houses. They can 
erect and maintain hospitals for infectious cases. In Dublin, rich and 
poor can have their houses, clothing, and bedding disinfected without 
charge. Under the Public Health acts, a small army of municipal sani- 
tary inspectors have been enlisted in the British and Irish towns, and 
their salaries are in part provided by parliamentary grants. Unhealthy 
areas may be cleared away, and the municipal authorities may either build 
healthful dwellings upon the cleared sites or dispose of them for that pur- 
pose to companies or private persons. 

Baths and wash-houses have been constructed by the sanitary authori- 
ties in Dublin and many other towns. The difficulty in the way of enforc- 
ing cleanliness in the yards and sanitary offices of the tenement-houses is 
well known to health officers ; in Dublin the sanitary authority, acting at 
my suggestion, has undertaken this work itself. This sanitary authority 
has the power of prescribing the form of sanitary accommodation in con- 
nection with every kind of dwellings, and in the Dublin corporation act of 
1890, it is provided that a house with a built (/. e, stone or brick) drain is 
to be regarded as if it were unprovided with any drain. In such cases the 
authority can enforce the construction of a pipe drain. 

It will be seen then, that the tendency in modem times is to concen- 
trate the population on very limited areas ; and already in some countries, 
such as England, Belgium, and Saxony, the majority of the people are of 
the towns and not of the country. It is, therefore, of the highest national 
importance to such states, and indeed to all states, that the utmost atten- 
tion should be given to the subject of civic public hygiene. There can be 
no question as to the physical advantages which accrue to those who are 
bom and reared in the open countries or in small hamlets and villages. 



IMPORTANCE OF CIVIL PUBLIC HYGIENE. 189 

The influences of town life on health being, on the whole, unfavorable, 
every effort should be made to minimize these effects. In the case of 
densely populated cities — which are by no means confined to the old 
world — narrow, ill-lighted, and badly ventilated courts, lanes, and alleys, 
should be replaced by wide streets. It may be very fine, from an archi- 
tectural point of view, to build houses a dozen stories high ; but it really 
means stratification of the people and obstruction of the circulation of air and 
light. I should not like to live in a house with ten strata of families over me. 
Playgrounds easily accessible to children, and town parks available to all 
classes, should be liberally provided ; they would form excellent lungs for 
the towns. The storage of filth in towns is an evil often of great extent. 
The effete matters should be removed in the most expeditious, complete, 
and cleanly manner practicable. The deposition of filth in the soil of a 
town should be made a penal offence. I am quite satisfied that much of 
the enteric fever, and diphtheria of towns arises from the filth-saturated 
condition of the soils. Slaughter-houses and dairy-yards contribute no 
inconsiderable proportion of the impurities of the air and soil of towns. 
The slaughtering of animals intended as food for man should be conducted 
in public abattoirs erected on the outskirts of the town. The processes 
of preparing the carcasses for use, can be conducted in such places in a 
more cleanly manner than is possible in small private slaughter-houses sit- 
uated, as they generally are, in densely inhabited districts. Besides, the 
inspection of the carcasses of animals, in order to discover disease, if pres- 
ent, cannot be satisfactorily carried out in private slaughter-houses. As 
for dairy yards, it is impossible to prevent them from being nuisances if 
they are in crowded parts. The removal of manure from them is an oper- 
ation which, in warm weather, can sometimes be smelled at a considerable 
distance. With respect to the effluvia from chemical works, artificial 
manure factories, it is difficult to completely prevent them ; but under 
the supervision of skilled inspectors these kind of works might be rendered 
much less noxious than they are at present. The efficient sewerage of a 
town is a prime factor in its sanitation, and the disposal of the sewage 
itself must be effected in such a way as to prevent it from being injurious 
to health. In Great Britain the " precipitation " and " irrigation " systems 
combined seem to be the favorite plan with the chemists and engineers. 

The compulsory notification of infective diseases should be adopted in 
every town. A British act of Parliament enables local authorities to adopt 
this system, and the principal cities have decided to put the act in force. 
It is of great advantage at all times, but more especially when such a 
disease as cholera may be expected. The prompt notification of a first 
case of this disease might enable such action to be taken in reference to 
it as would effectually prevent it from spreading. The British and Irish 
public health acts enable local authorities to maintain hospitals for cholera 
cases and to acquire, by agreement or compulsion, sites to erect them on. 
They are also empowered to construct and maintain hospitals and conval- 
escent homes for infectious cases. The corporation of Hull have lately 



190 IMPORTANCE OF CIVIL PUBLIC HYGIENE, 

expended thousands of pounds in preparing for a possible invasion of 
Asiatic cholera. A hospital ship, a hospital on land, a band of trained 
nurses, and a staff of medical men are the means by which Hull has 
hitherto resisted the rather frequent attempts of cholera to spread through 
the town. To the vigilance of the seaport towns of Great Britain, we are 
mainly indebted for the comparative freedom from cholera which the 
United Kingdom has enjoyed in 1892 and 1893. 

The new world has an advantage over the old one in reference to the 
hygiene of towns. The new towns of the great republic of the west can be 
readily laid down on sanitary lines. Their streets can be wide, and their 
drainage system can be the most approved system. In most of the towns 
of Europe it requires almost reconstruction to bring them up to the modem 
standard of sanitation. In the United Kingdom this reconstruction is 
gradually but surely taking place ; but on the continent, some of the towns 
are still as filthy as they were in the Middle Ages. This is the reason why 
Asiatic cholera still ravages Europe. 

The maintenance of a large sanitary staff, and the adoption of the well- 
known measures necessary for the preservation of public health, involve a 
large expenditure of money. This will not be grudged by the tax-payers 
if they feel that the money will be well expended and that it will give a 
good return in the shape of increased length of life and diminished illness. 
It is desirable to educate public opinion up to this happy state of belief, 
and this can be done best by the popular lectures and writings of earnest 
sanitarians and by the teachings of sanitary science in our schools and 
colleges. 



XXXVIII. 

REPORT OF THE COMMITTEE ON THE POLLUTION OF 
WATER-SUPPLIES. 

The last report furnished by your committee five years ago, at the meet- 
ing in Milwaukee, Wis., gave full expression to the danger from typhoid 
fever in water-supplies contaminated with sewage, and also to the inade- 
quacy of chemical and bacteriological methods to determine in most in- 
stances, not only the specific poison of the fever but even the sewage it- 
self. These failures, however, on the part of the laboratory workers, were 
considered to be of small importance practically, since the liability to 
sewage contamination could be discovered by sanitary inspection ; and ex- 
perience showed the only safe rule of practice to be that which condemned 
the use of all sewage polluted waters as sources of supply for potable and 
household uses. The value of pure water-supplies in eradicating endemic 
typhoid fever was also shown ; and owing to the difficulties attending the 
application of radical measures where public water-supplies are concerned, 
full consideration was given to methods in use for lessening the evil by 
improving the character of doubtful supplies. As an illustration of the 
method of sedimentation the basins of the St. Louis supply were instanced, 
but their value was acknowledged in general terms only. The storage of 
a turbid water in such basins undoubtedly tends to improve its quality. 
The subsidence of the inorganic matters which constitute the mass of the 
turbidity carries down a considerable proportion of the associated organic 
particles, and the clear water gives markedly better results as well on 
chemical analysis as on bacteriological examination. The tendency of 
the cleared water is to further purification by the resolution of organic 
matter into ammonia, nitrous acid, and finally nitric acid. This is effected 
by bacterial agency, and as these organisms increase at the expense of the 
organic matter which they destroy, the water as it becomes purer chemi- 
cally becomes less pure when the number of bacteria in a given quantity 
is made the standard of comparison. 

Your committee has no reports of sickness from the city of St. Louis, 
bearing on the quality of the water-supply ; but, fortunately, the health 
statistics of the recruiting depot, Jefferson Barracks, Mo., one of our 
largest military posts, have been placed at our disposal, and from them we 
have learned some of the advantages accruing from the treatment of the 
river water in the storage basins of the city. The water-supply of this 
post, prior to 1888, was pumped directly from the river and so much sick- 
ness was attributed to its use that the post surgeon urged, as the most de- 



192 REPORT ON POLLUTION OF WATER-SUPPLIES, 

sirable improvement, a connection with the mains of the city. The ad- 
missions to sick report in 1885 were 3,155 per thousand of strength pres- 
ent ; in 1886, 3,008, and in 1887, 2,133. In 1888, the year in which the 
city water was introduced, the rate began to decline, and in 1889 it fell to 
966 and during the three years i89o-'92 it was reported respectively 
as 1,000, 1,008, and 875. These latter rates are very considerably below 
the average rate of the army, notwithstanding that the post is garrisoned 
by recruits among whom there is always a greater sick rate from certain 
easily preventible diseases unconnected with the water-supply than among 
other soldiers. The water is passed through a sand and gravel filter in 
the water tower of the post prior to distribution, but there is no doubt that 
its main purification is effected in the sedimenting basins. Malarial 
diseases were specially lessened by the introduction of the sedimented 
water. 

In our last report we referred to the expense of storage basins, and to 
the unsatisfactory results of attempts at filtration on the large scale due 
to the expense of running and the coldness of our winters, as the causes 
which had given such an impetus to the construction of filters for domes- 
tic use. These filters having proved a success on the small scale, led 
their manufacturers to more ambitious efforts and rapid filtering ; self- 
cleaning filters were made first for hotels, manufactories, hospitals, etc., 
and afterwards for muncipalities. The passage of water through a filter- 
bed, the regular cleaning of the filtering material and the addition of iron, 
alum, lime, or other precipitant, to the water, are the essentials of these 
filters. No satisfactory chemical or bacteriological demonstration of the 
value of this filtration has been brought to our attention, nor have official 
statistics been brought forward showing a diminution of sickness due to 
the use of the waters thus filtered. 

The subject of filtration, however, has received great attention at the 
hands of the state board of health of Massachusetts, during the past few 
years. The reports of the board on the filtration of sewage and water, 
the chemical precipitation of sewage, and the purification of water and 
sewage, giving the details of the work at the experimental station at Law- 
rence, Mass., are valuable additions to our knowledge of those subjects- 
Among the points of importance demonstrated by these experiments is 
the possibility of separating the bacillus of typhoid fever from all other 
bacteria hitherto encountered in the waters of the Merrimack river. 

A step in advance has also been made in determining the sanitary con- 
dition of river water-supplies, as a result of investigations carried on for 
the New York state board of health, by Professor Charles C. Brown. 
An inspection of the Mbhawk and Hudson rivers revealed the extent and 
rate of increase of the pollution of the rivers by the drainage and sewerage 
from the population and manufactories upon their water-shed. Following 
this an investigation of the effects of this pollution upon the water was 
begun, at first along the usual lines of chemical analyses of the water and 
determinations of the number of bacteria. Samples were taken from 



REPORT ON POLLUTION OF WATER-SUPPLIES. 1 93 

points short distances apart along the course of the rivers. Comparisons 
of these analyses with the known amounts of pollution at the various 
points, indicated that the results of the chemical examinations could not 
be depended upon to give definite and unmistakable indications. The 
comparisons of results, taken under varying conditions, showed that the 
number of bacteria, determined by the usual gelatine plate method, gave 
much more definite indications, provided that the stage of water was fav- 
orable and that a series of sufficient extent along the course of the river 
was taken ; /. ^., to determine the condition at a single place, a study of 
the river for a considerable distance above must be made at a favorable 
time when the sewage pollution is practically the only cause producing in- 
crease in numbers. Rains and snow increase the numbers enormously, 
this increase giving no indication of the amount of increase in pollution 
from dangerous sources. It is evident that if a measure of the numbers 
of bacteria from such dangerous sources could be obtained, a measure of 
the amount of such dangerous pollution would be secured. The step in 
advance was made at this point. In discussion of the question. Dr. Theo- 
bald Smith suggested the use of bacillus coH communis as a measure of 
the numbers of bacteria from dangerous sources, owing to the fact of its 
general occurrence in the intestinal discharges of man and the higher 
animals, and its practical failure to proliferate in ordinary running water 
while persisting therein for a considerable length of time. He suggested 
the use of fermentation tubes containing a sterilized bouillon and glucose 
as an easy method of determining the numbers, the amount of gas pro- 
duced by it and its related species being a known quantity. A method 
of determining its number was soon elaborated and applied in practice to 
samples taken from various points in the river. Thus far special studies 
have been made of the water-supply of Albany from the Hudson, and of 
Schenectady from the Mohawk, and a study to determine the rate of dis- 
appearance of the sewage of the city of Schenectady is now in progress. 
So far the indications are strong that a method has been found which will 
show the relative amount of pollution from sewage and similar dangerous 
matter definitely, enabling an expert in water contamination to render a 
definite opinion of the chances of serious consequences from using a given 
water in its polluted condition. It gives the effect of the sewage pollution 
observed in the inspection, and leaves out the comparatively unimportant 
pollution from vegetable matter which is inextricably entangled with that 
from dangerous sources in the results of chemical analysis and in the de- 
terminations of numbers of bacteria in general. 

Important information with regard to the value of filtration has been 
contributed by the experience of the medical officers of the French army. 
In a communication from the minister of war to the president of the 
republic, February 20, 1890, attention was invited to the gratifying de- 
crease in the sickness and deaths from typhoid fever that had attended 
the introduction of pure water-supplies. Bacteriological analysis in the 
laboratory at Val de Grace showed that the water at a third of the mili- 



194 REPORT ON POLLUTION OF WATER-SUPPLIES. 

tary stations was capable of developing epidemics of typhoid fever. The 
remaining two thirds, although supplied with so called good water, proved 
deceptive in several instances, owing to the fact that sufficient precaution 
had not been taken to protect the springs or reservoirs from coming in 
contact with contaminated water. The measures adopted at first were 
the closing of impure wells and the substitution of good spring water. 
The result was manifested in the lessened prevalence of, and mortality 
from, typhoid fever. In 1889 there were 4,412 cases, while the average of 
the three preceding years was 6,215 ; the deaths in 1889 numbered 641, 
as compared with 843, the average of the three preceding years. Since 
then filtered water has been provided for the stations where spring water 
was not available, with a further and very notable diminution of typhoid 
fever. The filter is composed of Chamberland-Pasteur bougies placed in 
concentric circles on the inside of a metallic reservoir capable of receiving 
water under a pressure of three atmospheres. For a company of infantry 
a filter of twelve bougies is allowed with a reservoir having a capacity of 
150 liters. The officers of the medical department are responsible for the 
proper working of the filters and their cleansing and sterilization when 
bacilli of a dangerous character are discovered. . 

While the use of a water purified by filtration has in France been followed 
by a reduction in the number of localized outbreaks of typhoid fever, the 
use of a water purified by distillation has in this country, and particularly in 
those localities where malarial diseases were prevalent, been followed by 
such a diminution in the prevalence of these diseases that the sanitary 
reputation of the place has been changed from unhealthy to salubrious. 
Places supplied with distilled water are fre6 also from epidemics of 
typhoid fever. The chairman of this committee invited attention, at the 
last meeting of the Association, to the extraordinary change in the charac- 
ter of the diseases reported from the military post of Fort Brown, Texas, 
following on the use of condensed water from an ice machine instead of 
the turbid and impure water of the Rio Grande. This post, formerly a 
notoriously unhealthy one from malarial fevers developed, as was supposed, 
from the lagoons and marshes which surround it, is now free from these 
fevers, although the lagoons and marshes still continue to exist in the 
neighborhood as in the days when its garrison was prostrated by remit- 
tent fevers. 

Professor Maurice Perkins of this committee brings personal experience 
to the support of such facts as have been reported by our army medical 
officers from Forts Brown, Ringgold, and other Texan stations. He 
states : 

It is very desirable that the character of the water used by a community should be as 
nearly as possible of the same quality during the whole year, as we frequently find the 
prevalence of epidemics coincident with flooded rivers, melting snow, or extreme lowness 
in the river. For this reason an underground source is the best, the most wholesome, 
though perhaps from its greater hardness not so well fitted for manufacturing purposes. 
In the manufacturing esublishments of Schenectady, great complaint has been made 
about the effect of the Mohawk river water, sometimes as many as 200 out of 2,000 in 



REPORT ON POLLUTION OF WATER-SUPPLIES. 195 

one establishment being on the sick list. In the spring of 1891 I recommended the 
Schenectady Locomotive Works to furnish their workmen with distilled water, cooling it 
with ice of known purity in the sununer. This they did, and the manager reports to me 
that during the hot months of the summer of 1892, out of nearly 2,000 men employed^ 
never more than ten were laid up from bowel troubles. At first the men did not like the 
water, but soon became convinced as to its dietetic value, and at the commencement of the 
last summer arrangements were made that the men could take the distilled water to their 
homes. The closing of the shops during this time, however, prevented a renewed ex- 
perience this summer, but so thoroughly is this company satisfied with the result that 
they have lately improved their facilities for furnishing distilled water to their workmen 

As to the chemical methods of determining the wholesomeness of 
water-supplies, little advance has been made since our last report. 

A great deal of experimental work has been done in the various labora- 
tories, but cultures and the microscope have not yet succeeded in giving 
definite replies to questions as to the presence of specific infections in 
water. Although it is claimed that the bacillus of typhoid can be distin- 
guished from others in several ways by special treatment, yet in testing 
the water of a suspected well or river negative results only can be ex- 
pected. The bacillus may be present in the well, or in a tumblerful of 
the water from the well, but its presence may not therefore be demon- 
strated in the minute fractional part of the tumblerful submitted to ex- 
amination. Hence the value of the suggestion to inquire into the pres- 
ence of those more common organisms that would probably be associated 
with it. 

Sedimentation purifies water from its suspended matters, and also from 
dangerous bacterial organisms to an uncertain extent, and the same may 
be said of filtration. A theoretically perfect filtration will remove all 
particulate bodies, and thus free a water from bacterial organisms, and 
filtration as effected in laboratory experiments will do the same; but 
when effected practically for the purification of water-supplies, there is 
only a partial removal. 

In times of epidemic, or in malarious localities, the use of boiled or 
distilled water offers the best safeguard against the spread of disease by 
the water-supply. 

So far as regards the general question of the water-supplies of cities and 
towns, your committee sees no occasion to alter the record of its report 
made at the Milwaukee meeting in 1888. 

CHARLES SMART. 
VICTOR C. VAUGHAN. 
MAURICE PERKINS. 
JOSfe D. MORALES. 
JOSfe RAMIREZ. 



XXXIX. 

TUBERCULOSIS AND THE FOOD SUPPLY. 

By D. E. salmon, D. V. M., 

Chief of the Bureau of Animal Industry, 

Washington, D. C. 

The frequency of tuberculosis in mankind, and the great number of 
deaths which result from it, make it important for us to consider from 
time to time the possible means of prevention, and to inquire as to 
whether we are doing all in our power to this end. It is not my inten> 
tion to treat the subject at great length, or to enter into the details of 
scientific work which must be already quite familiar to the members of 
this congress. I desire rather to bring out clearly a few salient points, 
and to make some practical suggestions. 

I shall assume without argument as already established by scientific 
investigations that tuberculosis is a parasitic disease ; that it is caused by 
the multiplication of a specific micro-organism in the tissues of the animal 
body, and by no other means ; that this micro-organism has no habitat in 
nature outside of the animal body, that it may be distributed in various 
ways from this habitat and generally gains entrance to the bodies of 
its victims, either by being inhaled with the air in which it is floating or 
by being ingested with infected food or drink ; and, finally, that hereditary 
transmission of this disease has been greatly exaggerated as a factor in 
its production, and may, from a practical point of view, be left out of con- 
sideration. 

Of the two methods by which the disease is contracted, with men as 
well as with animals, it may be admitted that the most frequent, and, 
therefore, the most important, is the inhalation of the micro-organisms 
suspended in the inspired air. My paper, consequently, deals with the 
less important of the two principal modes of infection ; but while it is the 
less important etiologically, it is the more important from the point of 
view of preventive medicine, because it is more easily controlled by the 
efforts of sanitarians. 

I have no means of estimating the proportion of the cases of tubercu- 
losis which arises from infected food, but am prepared to admit that 
tuberculosis of the abdominal organs and tubercular meningitis, particu- 
larly of children, are generally caused in this way- For convenience in 
treating the subject, we must consider separately infection through the 
milk supply and infection through the meat supply. 



TUBERCULOSIS AND THE FOOD SUPPLY, 197 

Tuberculosis is one of the most common diseases of milch cows. It 
exists in many dairies, and may affect 50, 75, or 100 per cent, of the 
animals in large herds. We do not know the average proportion of 
affected cows in this country, but in the dairies around our large cities 
from three to five per cent, have been found affected when the diagnosis 
was made by the ordinary methods of examination. By the use of tuber- 
culin, a much larger number of infected animals is found. In Europe, 
by the use of tuberculin, from 50 to 80 per cent, of cows have been found 
to give the reaction when a considerable number was tested. In the 
United States, we have no statistics of the results of the tuberculin test 
except with herds known to be tuberculous. As many cases of the 
disease are revealed by tuberculin, however, which would not be discov- 
ered otherwise, it is certain that the proportion of affected cows in the 
United States, if not as large as in Europe, must nevertheless be very 
considerable. If no more than fifteen or twenty per cent, of our cows 
should prove to be infected, it would still be a very serious matter and 
one well worthy the consideration of this congress. 

Fortunately, the milk from all tuberculous cows does not contain the 
bacilli. When there are tubercles in the udder, however, the milk may 
contain immense numbers of these germs, and this is particularly the case 
if the tubercular mass softens and its contents escape into the milk ducts. 
The milk from cows so affected must be considered an extremely danger- 
ous article of food. 

In case there are no tubercles in the udder the milk of affected cows 
may or may not contain the bacilli, — generally it does not. As the dis- 
ease progresses and the vital forces are diminished, the number of bacilli 
in the milk and the frequency of their occurrence increases. In other 
words, the nearer we approach the death of the animal the more certain 
we are to find bacilli in the milk. At this period the milk secretion is of 
course greatly diminished, and may entirely cease. 

The danger from using infected milk increases with the number of 
bacilli which such milk contains, and decreases with the degree in which 
it is mixed with the milk of healthy cows. If there is but one tuberculous 
cow in a large herd, and the milk of the herd is all mixed together before 
it is consumed, the danger to the public health would largely disappear, but 
if the milk is not so mixed, or if a large proportion of the herd is tubercu- 
lous, then the danger would be correspondingly greater. 

With these facts before us, we are prepared to consider the great prac- 
tical question. How can the prevalence of tuberculosis in dairy cows be 
lessened, and the danger from infected milk be diminished ? Evidently 
the accomplishment of this object requires a careful and periodical inspec- 
tion of the herds from which the milk supply is obtained. This inspec- 
tion must consist not only of a physical examination, but must also 
include the tuberculin test. There must in addition be some means 
provided for securing the destruction of animals found to be tuberculous. 
The great obstacle to the introduction of such measures will no doubt be 



ipS TUBERCULOSIS AND THE FOOD SUPPLY, 

found in the expense which must necessarily be incurred. The test with 
tuberculin requires time, and the animals must be kept under constant 
observation for at least two days. This makes it necessary to have a 
larger number of inspectors than would otherwise be the case. 

Tuberculin has been very expensive and difficult to obtain in large 
quantities. Recently the Bureau of Animal Industry has been preparing 
it, and furnishing it to state and municipal boards which have the subject 
of tuberculosis in animals under their jurisdiction. It has seemed to me 
that this was one of the most practical methods of cooperation between 
the national and local authorities for controlling this disease, and I hope 
the bureau may be able to continue it, and increase its facilities to keep 
pace with the demand. This, however, depends somewhat upon the ap- 
preciation with which our effort meets, and the support which is received 
from those interested. With an unlimited supply of tuberculin furnished 
without expense by the (Government, or even for the actual cost of its 
preparation, the problem of control is considerably easier. 

Nevertheless, the difficulties at best are enormous. Eighty percent, of 
a herd may react to the tuberculin test. Of these some will be advanced 
cases of generalized tuberculosis, with the mammary glands affected. 
The disposition of such cases would be an easy matter. A larger num- 
ber, however, would be but slightly affected, and would require a most 
careful post-mortem examination to discover the lesions. In some, it 
would be impossible to find any lesions. Many cattle would, therefore* 
be condemned by the tuberculin test, the milk of which would be per- 
fectly wholesome ; and, on the other hand, some cows in an advanced 
stage of tuberculosis^ with very prominent lesions, show no reaction to the 
tuberculin test. 

It must be evident from these statements that while tuberculin is a 
great aid to the diagnosis of tuberculosis, it is not infallible, and may 
lead to some errors. It is also evident that the disease cannot be eradi- 
cated with certainty by our present means of diagnosis, unless every 
animal in an infected herd is slaughtered. On account of the extent 
and distribution of this plague, the slaughter of all herds in which tuber, 
culous animals are found does not appear to be practical. 

If by the tuberculin test we could infallibly detect every infected 
animal, it would be possible to establish herds free from the disease, and to 
maintain this freedom by testing all additions to the herd. This was the 
hope inspired by the first experiments made with this remarkable agent. 
Later, when it was found that some tuberculous animals did not respond 
to the teat, those interested in the subject became more or less discour- 
aged, and have settled down to the conclusion that tuberculosis is still an 
unconquerable disease, as it has always been in the past. Theoretically 
this conclusion is correct, but there is often a wide difference between 
theory and practice, and the conclusions from laboratory experiments, and 
from a few tests in the field, should not be allowed to arrest our efforts in 
this direction. 



TUBERCULOSIS AND THE FOOD SUPPLY, 199 

Whatever may prove to be the proportion of tuberculous animals in the 
dairies of the country as a whole, I know from experience that many herds 
of cows are entirely free from the disease. This may be proved, both by 
the history of the herds, and by the tuberculin test Now, taking such 
herds as a starting-point, with proper precautions to prevent their infec- 
tion, I believe it quite possible to breed a race of cattle practically free 
from the disease. And while this is being done, the known infected herds 
should be destroyed. 

A great work like this cannot be accomplished by an individual, nor by 
a single board of health. There must be co-operation, a unity of effort, 
and the combined influence and power of the nation, the state, the local 
authority, the dairymen, and all organizations that are interested. Many 
individuals would resist, and endeavor to obstruct any efforts in this direc- 
tion ; there would be predictions of failure from persons of influence and 
authority ; there would be unforeseen discouragements. Some herds would 
doubtless be infected by the sputa of tuberculous attendants, — others by 
contamination from different species of animals ; but such cases, I think, 
would be comparatively rare, and by S3rstematic inspection should be 
detected before much progress was made. 

While, therefore, the complete eradication of tuberculosis among dairy 
cows may be a dream and theoretically impossible, I firmly believe, that, 
by educating the public and by the united effort of those in authority, the 
extent of the disease might be reduced to insignificant proportions. 

It will be at once asked if the result would be of sufficient importance 
to justify such an extraordinary effort and expenditure. This, of course, 
is a difficult question to answer, and it might be well to have extensive and 
accurate observations made, with a view to determining more definitely the 
mortality from tuberculosis induced by infected milk — ^particularly with 
children. My impression is that very valuable results might be obtained 
by such an inquiry, and I should be glad to see it made by a committee of 
the American Public Health Association. 

In addition to the effect on the public health, the control of tuberculosis 
in cattle would save the loss of much property from the ravages of this 
disease, and the healthy cows taking the place of diseased ones would 
yield a much greater income to their owners. With the prospect of results 
so important as this, the subject is one deserving the most careful consid* 
eration. 

Infection through the meat supply is apparently a less important ques- 
tion from a sanitary point of view. Although tuberculosis may be general- 
ized, and the bacilli scattered through the various organs of the body, the 
proportion of infected animals is much smaller with beef cattle than 
with milch cows, and the disease when found is generally less extensive. 
In addition to this, cooking must in many cases destroy the bacilli. It 
must be admitted, however, that meat is often eaten so slightly cooked that 
the bacilli would not be injured by the heat to which they have been sub- 
jected, and also that the carcasses of many tuberculous cows are put upon 



200 TUBERCULOSIS AND THE FOOD SUPPLY. 

the market by unscrupulous persons, and the meat consumed by an 
unsuspecting public. 

We have now a national meat inspection in many of the largest abattoirs 
of the country, and this is being gradually extended and its workings per- 
fected. The national inspection, however, only applies to animals and 
meats which are the subjects of interstate or foreign commerce. Abattoirs 
where animals are killed exclusively for local consumption in the state 
where they are situated, do not come under the national jurisdiction. The 
tendency is, therefore, for such establishments, if they can avoid muni- 
cipal inspection, to slaughter animals which would probably be condemned 
under the national inspection. There is, consequently, a necessity for 
even greater precautions by the city boards of health to prevent the 
slaughter of diseased animals for food than there was before the national 
inspection began. 

There are all degrees of tubercular infection found in cattle at the time 
of slaughter. The distribution of the lesions is often general, and nearly 
every organ of the body is occasionally found affected, or but a single small 
gland maybe invaded, and this so slightly that a positive diagnosis can only 
be made after a microscopic examination. Between these two extremes the 
disease is found in all degrees of progress. In the earliest stages of the 
disease, or in the milder forms of infection, it is generally admitted that 
the flesh is wholesome and free from danger, but the tubercular organ 
should of course be destroyed. In the advanced and generalized cases 
there can be no doubt that the whole carcass should be destroyed. There 
is here, as with other diseases and unwholesome conditions, some difficulty 
in drawing a line for defining exactly which carcasses shall be condemned 
and which shall be allowed to go into consumption. In case of doubt, the 
consumer should have the benefit of the doubt, and the carcass should be 
condemned. The inspector must, however, act in the light of science and 
modem investigation, and should not be led by ignorance and prejudice 
to destroy articles of food which are wholesome and free from danger. 

If a large organ, as for example a lung or liver, is extensively invaded, 
or if several organs, such as the lungs, liver, and lymphatic glands, are 
involved, the carcass should certainly be destroyed. If this rule were 
enforced at all abattoirs, thousands of carcasses, which in the past have 
gone into the meat supply, would in the future go to the rendering-tanks 
for manufacture into fertilizers. It seems to me that this could not fail 
to have considerable influence of a favorable character upon the public 
health. 

I wish it were possible for me to make more definite statements as to 
the value of the inspection of dairies and meats as a means of preventing 
tuberculosis in people. There is so much uncertainty as to the proportion 
of the cases of human tuberculosis which arise from the ingestion of in- 
fected food, that it appeared to me preferable to avoid speculation in regard 
to it in the present condition of science. The most that can be said is, 
that infected food must be an important factor in the production of the 



TUBERCULOSIS AND THE FOOD SUPPLY. 201 

disease, and it is the one which is most easily controlled. I have for years 
believed in the desirability of a thorough inspection of milk and meat, as 
one of the first measures to be adopted in the endeavors to diminish the 
prevalence of this disease, and while my opinions as to the danger from 
infected food have been somewhat modified, on this general proposition 
they are unchanged. 

What is needed is a continued effort to extend and perfect the national 
inspection of meat until all which goes into the interstate and foreign trade 
comes under its operation. This should be supplemented by a far more 
perfect system of municipal inspection of the animals killed for local con- 
sumption than exists in any city of this country at the present time. 

The inspection of milch cows, and an effort to control tuberculosis in 
dairy herds, is no less important. The national government has not yet 
attempted to make such an inspection, and there are many obstacles to 
prevent such action, the chief of which is the doubt of its power under 
the constitution to enforce regulations concerning the cattle of any par- 
ticular state, the milk from which is sold within that state. By co-operation 
between the national and local authorities, however, it is quite probable 
that all of these obstacles might be overcome. The subject is of such 
great importance that it merits an earnest effort in this direction, and I 
trust that the discussion of the subject before this congress will hasten the 
time when such an effort shall be made. 



XL. 

SOME CONSIDERATIONS ABOUT THE INFLUENCE OF HAB- 
ITATION IN THE DEVELOPMENT OF TUBERCULOSIS. 

By MANUEL GUTIERREZ, 
Mexico^ Mex, 

Mr. Chairman, Ladies and Gbntlembn : It is a perfectly investiga- 
ted fact that pulmonary tuberculosis is more frequently observed in the 
United States than in the Republic of Mexico. The statistical records 
give a proportion of ii8 or 120 per thousand in this beautiful country, 
while in our sunny Mexico it does not reach the number of 60 to every 
thousand ; it is true that one of the causes which contribute to produce 
so notable a difference in the propagation of so dangerous a disease as 
tuberculosis, is the difference of the elevation in both countries, because 
we know that dry air is not a vehicle for the multiplication and generation 
of the bacillum of Koch and the relative rarefaction of the air is in a di- 
rect ratio to the elevation. Mexico being 2,257 metres above the sea 
level, it is consequently not difficult to explain its superiority in arresting 
the conditions favorable to the propagation of a disease which undermines 
so many constitutions ; even as important as may be the said factor, great 
as may be its preponderance, it is not the only one, and among the oth- 
ers exists one of great interest. A simple remedy, but one the action of 
which seems to me unquestionably of great importance, is the arrange- 
ment of the dwellings, both public and private, in the United States in 
which pure air and light are excluded from many of the chambers. 

During my stay among you, my attention has been called to the fact 
that not only in the hotels and public establishments but also in private 
dwellings, there are rooms constantly illuminated with artificial light, and 
where the light of the sun never penetrates. The individuals who work 
or reside therein, find themselves deprived for many hours of the bene- 
ficial action on the economy that we know solar light exerts, and well do 
we know these privations and the special conditions that accompany 
them, can contribute to the development of tuberculosis, — 

I St. By producing anemia and its consequent state of malnutrition, 
preparing, as it were, the ground that serves for the cultivation of the 
germs of the disease. 

2d. Increasing considerably the temperature of the place illumbated, 
that constitutes also a propitious cause of multiplication of the pathogenic 
principles involved, and in the tuberculosis process. 



DEVELOPMENT OF TUBERCULOSIS. 20^ 

Among the dwellings of which I speak, the unfortunate dwellers, de- 
prived of the air of heaven, unpurified by the action of the solar rays, are 
also forced to respire the air which had already been contaminated by the 
carbon dioxide exhaled from the air passages of their co-laborers. 

Your dwellings have great and elegant conditions of comfort and beau- 
ty, particularly the hotels, which have no equal in any country ; why not 
unite with so many good qualities, those of a perfect hygiene, by sending 
to the different rooms the elements most necessary to life, the natural an> 
tiseptics par excellence, such as the light of day ? 

In Mexico the poor eat insufficiently, are not well dressed, and live in 
uncomfortable houses ; nevertheless, they enjoy the sunlight and the air^ 
and are less liable to tuberculosis. With great reason the tuberculosis 
contingent diminishes among persons well accommodated in dwellings, 
with reduced number of floors, well illuminated, adorned with court-yards, 
halls, and windows, and where their lodgers dwell under the excellent hy- 
gienic conditions I have pointed out as necessary to health. 

The considerations contained in this paper have no other object, there- 
fore, than to attract the attention of the sanitary authorities here united. If 
they estimate properly the fact that while sanitariums are doing every- 
thing in their power to stop the encroachments of this dread disease by 
the disinfection of sputa charged with broken down tuberculous lung tis- 
sue, and by the disinfection of clothing of tuberculous patients or of those 
with whom tuberculous patients have come in contact, and who are also 
critically investigating the food and water supply, to see if it be not 
charged with the dread bacilli of Koch, I would ask if it would not be 
well to place in the front rank the conditions existing in modern dwellings 
where thousands are daily deprived of that great natural aseptic agent, the 
pure air of heaven, and whether it would not be well in their labors to at- 
tend to this primal want in the consideration and treatment of tuberculo* 
sis. 



XLI. 

CAN SYPHILITIC CONTAGION FORM THE VEHICLE FOR 
THE TRANSMISSION OF TUBERCULOSIS AS WELL? 

By Dr. MANUEL CARMONA Y VALLE, 

Director of the National School of Medicine of Mexico, Professor of In- 
ternal Clinics, Member of the Academy of Medicine of 
Mexico, and Several Scientific Societies, 

Mexico^ Mex. 

Gentlemen : The principal object of hygiene is to prevent the spread 
of disease, and for that reason the students of this science ought to give 
a special attention to the diflEerent ways by which disease-producing agents 
can eflEect an entry. 

This duty becomes more imperative as we consider the gravity of the 
disease which we desire to prevent, and from this point of view, there 
are very few morbous conditions that can be compared to that of a person 
suffering from tuberculosis. In fact, once the bacillus of this dread dis- 
ease has taken possession of our internal economy, it is almost certain, 
sooner or later, to terminate the life of the patient. 

Science progresses greatly from day to day; great hopes have from 
time to time been formed of finding a means by which to conquer one of 
the greatest enemies of humanity, but unfortunately, as far as our thera- 
peutic knowledge goes, we are at present in the same defenceless con- 
dition that our forefathers were. 

Happily the bacteriological studies of the present day have given us a 
knowledge of the pathogenic agent of the disease, and guided by this 
knowledge, our studies can take a more exact and scientific form. It is 
possible now to find some agent which will destroy the bacillus of tuber- 
culosis ; it is possible to discover the means of giving to our nature a 
character opposed to the reception of the germ ; and lastly, it is possible 
that we may reach a knowledge of the different ways in which it penetrates 
the human organism, thus placing ourselves in a position to close the 
doors that serve it as an entrance. 

The case that I now propose to relate to this honorable meeting demon- 
strates, perhaps, the possibility of an association of syphilitic virus and the 
pathogenic agent of tuberculosis ; and if such association occurs in an ul- 
ceration, it is very possible that its product may not only transmit syphilis, 
but tuberculosis as well. It has already been clearly proved that the vac- 
cine virus can be associated with syphilitic virus, and that under certain 



SYPHILITIC CONTAGION— TUBERCULOSIS, 20$ 

circumstances, it is very possible to transmit at one and the same time 
the eflEects of both. Cases of this class have come under my own obser- 
vation several times, and we have so many such cases mentioned in scien- 
tific books with the minutest details, that it is not possible to doubt their 
truth. 

On the other hand, nobody can deny the great similarity that exists be- 
tween tuberculosis and leprosy ; both on account of the similarity of the 
pathogenic microbe, as well as from the fact that persons suffering from 
either of these diseases are equally sensitive to the effects of the tubercu- 
lina of Koch. Now, in the Congress for the study of tuberculosis 
which met in Paris during the month of July last, it was clearly demon- 
strated, by Messrs. Strauss and Teissier, that individuals suffering from 
syphilis are as susceptible to the action of tuberculina, as the consump- 
tive patients themselves. 

But let this be how it will, the observation which I am about to relate, 
is, in my opinion, of the greatest importance, and for that reason I shall 
give it with full details. 

N. N. is a Spaniard, 28 years of age, and of a rather delicate constitu- 
tion, although the son of healthy parents ; he contracted a syphilitic ulcera- 
tion, situated in the gland, accompanied by a discharge characteristic of gon- 
orrhoea. Eight days after the appearance of the first symptoms, he came to 
consult me, and with the remedies which I prescribed the discharge was 
easily suppressed ; but the same did not happen with the ulceration, which 
resisted all the medicaments which are usually applied to the cure of 
chancre. The ulceration continued extending, and little by little increas- 
ing in depth ; the inguinal ganglia greatly swelled, and formed a manifest 
pleiades, without the slightest tendency to suppuration. Three months 
passed in this manner, and at the end of that time a syphilitic roseola ap- 
peared on the breast, which was shortly followed by some pustules in the 
face and under the hair. Shortly after this, ulcerations appeared in the 
throat, which rapidly extended to the veil of the palate, to the phamyx, 
and to the palatine cavity. In one word, constitutional syphilis made it- 
self manifest in its most characteristic form ; but the remarkable part of 
the case was, that in the same way as the chancre had resisted every 
rational medicament, the secondary phenomena in the same manner 
resisted the action of mercurial preparations, sudorifics, iodides, ton- 
ics, etc. 

As the patient lived alone in a house, I suspected that the poor results 
obtained might be due to carelessness in following the method I had pre- 
scribed, and I therefore advised him to enter the Spanish hospital, where 
he would obtain the proper attention. He followed my advice and re- 
mained four months in that establishment. While he was cured of the 
chancre, by means of repeated and profound cauterizations, yet the gen- 
eral accidents of the disease, and especially the ulcerations of the throat, 
resisted every kind of treatment, even the different secret medicaments 
that in other cases have given good results. 



^06 SYPHILITIC CONTAGION-^TUBERCULOSIS. 

The patient having wearied of the hospital, he retired from that estab- 
lishment and returned to my consulting office. I then noted that he was 
completely broken down; that the ulceration of the gland had healed, 
leaving an iiregular scar, the organ being deformed through the destruc- 
tive operation of the ulcer. At the same time, the condition of his throat 
could not have been worse, the greater part of the veil of the palate hav- 
ing beeti already destroyed ; the ulceration had extended from the vault 
of the palate to the posterior wall of the phamyx, whilst pustules were 
<:onstantly forming and disappearing on his forehead and in his hair. 

Knowing that in the hospital he had been subjected to different mercu- 
rial treatments, both by means of the digestive organs and through 
the skin ; knowing also, that he had taken large quantities of iodide of 
potassium and of iodoform, I prescribed a series of tonics and other reme- 
dies to build up the system, accompanied by bodily exercise, generous 
food, pure air, and, by way of medicament, I made use of gold prepara- 
tions, intus et extra. The results of this method were as unfortunate as 
those which preceded ; the ulcerations in the throat were in no way alle- 
viated, and the patient was losing strength from day to day. I then rec- 
ommended him to go to Puebla and drink sulphurous waters, living at the 
same time in the country, taking exercise on horseback, and eating mod- 
erately well. 

Two months afterwards the patient returned in a still worse condition ; 
his throat was as bad as before, and his strength had greatly decreased ; 
but at the same time, he was suffering from fever and night sweats, cough 
and expectoration with purulent mucus. By percussion and ausculta- 
tion, I discovered evident traces of hardening in the vertices of both lungs, 
and a careful examination of the sputum convinced me that it contained 
numerous bacilli of Koch. 

This discovery at once threw a great light on the subject, as it induced 
me to suspect that the resistance to treatment was due to the fact that the 
' ulcerations in the throat were not only of a syphilitic character, but also 
S3rphilitico-tuberculous. In order to make certain, I made the patient 
wash his throat frequently, after which I cleaned it with cotton which had 
teen dipped in sterilized water. With a pair of forceps I then took a lit- 
tle of the pultaceous substance from the bottom of one of the ulcers, and 
this I submitted to the system of coloration which has been advised for 
the discovery of the bacillus of tuberculosis. The result was entirely con- 
clusive, as numerous bacilli appeared in the preparation. 

It is, therefore, evident that the ulcerations in the throat were of a syphi- 
litico-tuberculous character. 

The syphilitic nature of the disease is inferred from the entire history 
of the case : First, we have an improper connection, followed by a discharge 
and a chancre ; secondly, and three months afterwards, we have a sjrphi- 
iitic eruption and superficial pustules on the forehead and in the hair ; 
and lastly, we have the appearance of ulcerations in the throat. To com- 
plete the picture, we may add the manifest existence of the gangiionary 



\ 



\ 



SYPHILITIC CONTAGION— TUBERCULOSIS, 207 

pleiades which is characteristic of the disease, and which appeared in the 
inguinal regions. 

The tuberculous nature of the disease cannot be doubted after the dis- 
covery of the Koch bacillus. 

Having thus proved that the ulcerations in the throat were of a syphi- 
litico-tuberculous character, we can easily understand the resistance that 
they offered to the therapeutic methods which are usually employed 
against constitutional syphilis ; but it can also be inferred in a logical 
manner that the chancre itself was of a S3rphilitico-tuberculous character, 
seeing that it also presented a great resistance to all the different treat- 
ments to which it was subjected. Now, if I am right in my hypothesis, it 
is almost certain that my unfortunate patient was innoculated from an- 
other syphilitico-tuberculous ulceration, in which case we can admit the 
possibility of transmission of tuberculosis and syphilis at the same time. 

Nevertheless, we cannot as yet accept this theory, if we are to follow 
the severe rules of experimental science ; because although it is very 
probable that the chancre was of a syphilitico-tuberculous character, the 
fact has not been proved, and therefore can only be classified as a proba- 
bility. Consequently, the only indisputable result of the observations 
which I have now presented to this meeting, is that of having discovered 
together, in the ulcerations of the throat, the characteristic symptoms which 
showed that the ulcers were at the same time syphilitic and tuberculous. 

Now, if a syphilitic vaccine pustule can transmit both the vaccine as 
well as syphilis, is it not possible that a s3rphilitico-tuberculous ulceration, 
such as that which appeared in the throat of my patient, might simultane- 
ously transmit the two diseases of syphilis and tuberculosis ? 

This is the question that I now submit to the deliberation of this learned 
assembly. 



XLII. 

REPORT OF THE COMMITTEE ON RESTRICTION AND 
PREVENTION OF TUBERCULOSIS. 

At the Charleston meeting of the American Public Health Association 
a committee was appointed on the Restriction and Prevention of Tubercu- 
losis. Since then much light has been shed upon the question of 
tuberculosis from every quarter in which scientific medicine is active. 
Without going into details as to what experiments and clinical observations 
have been made and how conclusions have been arrived at, such informa- 
tion being at the command of every one in the current medical literature 
of the day, we desire to oflEer as our report the following conclusions and 
recommendations : 

I St. Tuberculosis has been conclusively demonstrated to be contagious, 
by bacteriological experiments, by clinical observations, and by a study 
of the history of the disease. 

2d. Tuberculosis is a preventable disease. Its preventability follows 
as a logical sequence upon its contagiousness, but has likewise been 
demonstrated in practical life. 

3d. The contagion of tuberculosis resides entirely and solely in broken- 
down tubercular tissue. A person suffering from tuberculosis therefore 
does not become a source of danger to others until he begins to give off 
broken-down tubercular tissue either in the form of sputa from the throat 
or lungs, diarrhoeal discharges from the bowels, or matter from a tubercu- 
lous sore such as lupus, white swelling, cold abscess, scrofula, or tubercular 
inflammation of a joint. 

4th. A person suffering from tuberculosis can be made entirely harmless 
to those about him by thorough sterilization of all broken-down tissue 
immediately upon its being given off. With proper precautions it is, 
therefore, possible to live in the closest relation and upon the most 
intimate terms with consumptives without contracting the disease. 

5th. Tuberculosis is not hereditary. A predisposition to the disease 
can be transmitted from parent to offspring, but this is no more true of 
tuberculosis than it is of all other contagious diseases. 

6th. A predisposition to tuberculosis can be created anew by mal- 
nutrition, or by anything which depresses the nervous system. 

7th. Tuberculosis affects animals as well as man, and is identically the 
same disease in both. In domestic life human beings and animals 
mutually infect each other. 



REPORT ON PREVENTION OF TUBERCULOSIS. 209 

8th. The media through which human beings are ordinarily infected by 
animals are milk and meat. 

9th. Houses in which consumptives have lived, and in which immediate 
sterilization of all broken-down tissue has not been practised, are infected 
houses, and are liable to convey the disease to subsequent occupants. 

loth. Spitting upon floors and into handkerchiefs, and permitting the 
broken-down tissue to dry and become pulverized, is a prolific cause of 
spreading tuberculosis. 

nth. Temporary occupation of hotel rooms, sleeping-car berths, and 
steamer cabins by consumptives in the infectious stage can infect them so 
as to convey the disease to subsequent occupants unless proper precautions 
are taken against contamination of the bedding, furniture, and walls with 
broken-down tubercular tissue. 

We reconmiend the following practical measures for the prevention of 
the disease : 

I St. The notification to, and registration by, health authorities, of all 
cases of tuberculosis which have arrived at the infectious stage. 

2d. The thorough disinfection of all houses in which tuberculosis has 
occurred, and the recording of such action in an open record. 

3d. The establishment of special hospitals for the treatment of 
tuberculosis. 

4th. The organization of societies for the prevention of tuberculosis. 

5th. Government inspection of dairies and slaughter houses, and the 
extermination of tuberculosis among dairy cattle. 

6th. Appropriate legislation against spitting into places where the 
sputum is liable to infect others, and against the sale or donation of 
objects which have been in use by consumptives unless they have been 
thoroughly disinfected. 

7th. Compulsory disinfection of hotel rooms, sleeping-car berths, and 
steamer cabins which have been occupied by consumptives, before other 
persons are allowed to occupy them. 

J. N. McCORMACK, 

Lawrence F. Floch, 
Henry B. Baker, 
George H. Ronii, 
J. H. Raymond, 

Committee, 



XLIII. 
OVERWORK AND UNREST. 

By WILLIAM OLDRIGHT, M. A., M. D., 

Professor of Hygiene in the University of Toronto, Surgeon to St. Mich- 
ael's Hospital, Lecturer on Hygiene, Ontario School of Pedagogy, 

T&ronio^ P. O, 

Mr. President, Ladies and Gentlemen : I have selected this as the 
subject of a short paper, because I think it has not been given that prom- 
inence before the public to which its importance entitles it ; and if we, as 
individuals and communities, would consider it more carefully, and put in 
practice the conclusions to which such considerations will lead us, we 
would be healthier, happier, and better people; and would reflect a 
greater degree of happiness on those around us. 

I shall never forget the startling freshness with which I heard for the 
first time an aphorism addressed to me by a sensible, sterling young 
friend, as a reason for not hurrying through a seaside holiday, — " You will 
be a long time dead 1 " How true of the material organism with which 
we are entrusted ! And how many hints does it suggest as to the care of 
this organism ! How abruptly does it call a halt in the mad rush towards 
" that dread bourne whence no traveller returns ! " 

Those who watch disease statistics must be aware of the increasing fre- 
quency of diseases of the heart. After making due allowance for the 
greater accuracy of diagnosis in late years, and for the great convenience 
of that term ''heart failure" to cover up inaccuracies and inconveniences 
of diagnosis which do occur ; it must still be admitted that diseases of the 
heart are more frequent than they used to be. Is this not largely due to 
the rush to finish work which has to be done, and then be on time to the 
minute in keeping some engagement, because the other man's time is at 
least equally precious, and neither of us can approach the appointment in 
the leisurely manner of former days.? Or because we have to run to 
catch the street car, or the suburban train ? And these repeated hurried 
actions become so habitual to people that they carry them out when they 
are unnecessary and senseless. We see this illustrated every day in con- 
nection with this wonderful World's Fair : when a train draws up to the 
point of embarkation, a rush is made as though life and happiness de- 
pended on being on board half a minute sooner than one's neighbor, or at 
least in avoiding the few minutes' delay in waiting for the next train; 
whereas a very little consideration would convince us that life will be 
lengthened and happiness increased by taking things more coolly and 
quietly. For those whose thoughts become too much disturbed and ruf- 



OVERWORK AND UNREST. 211 

fled to be enjoyed at such a season of irritation, an entertaining paper, 
a paper-cover book convenient for the pocket, may be a good prescription 
to make them forget the annoyance of waiting. 

While certain diseases of the brain have become less frequent owing to 
a decrease of intemperance and other improvements in our habits, other 
diseases of the nervous system, such as nervous exhaustion and mental 
derangements are on the increase. As causes, we may fairly refer to 
some of the needs which now exist for more rapid and increased thought. 
In our daily life, subjects for thought are brought more rapidly and fre- 
quently before our minds. The business man at one time, received his 
daily budget by the stage-coach, later on, his telegraphic despatches 
came to him once or twice a day, but now his indicator keeps up the 
mental strain all day long. His four-page newspaper he used to have a 
week or half a week to read ; now he has to skim it twice a day, and the 
process of selecting and mentally epitomizing is hard work. Besides, if 
the ubiquitous reporter thinks the lucubrations of his brain, or anything 
that has happened to him, will profit, amuse, or startle any considerable 
section of the public, the said brain, or any portion of it that is left, will 
again be drawn upon. The rapid fluctuations, the telephone, the tele- 
graph, and the host of modem appliances, necessitate increased and more 
rapid brain work ; and the machine must often wear out, wear feeble, or 
get a screw loose here and there. Our social enjoyments (a note of inter- 
rogation might sometimes be added to the word '^ enjoyment") are 
responsible for a good deal of mischief, — ^people assembling for recreor 
Han at an hour when they ought to be preparing to give the process of 
re-creation^ or rather the process of repairing and renewing the exhausted 
nervous system, an opportunity by going to bed. 

One might refer to some forms of dyspepsia, and otherwise lengthen 
out the Ibt of diseases attributable in part to the hurry, worry, and unrest 
of modem life ; but the foregoing are enough to invite us to the consider- 
ation of some practical remedies ; and, as I intended to make this paper 
short, I will not enter into an enumeration which may not help us now. 

One retribution that follows overwork is, that, like some of those 
pictured by Dante, the abuse must go on : when men would, in middle 
life or old age, retire from the arena of bustle, they find they have lost the 
power of enjoyment outside of it. 

We cannot go fully into all the causes for this rush and worry : some 
persons are individually helpless ; they must swim in the stream or sink, 
their only sensible course being not to choose the swiftest and most 
tumultuous currents. But how often must an outside view draw forth the 
exclamation, ''What fools these mortals be ! " Men shortening their lives 
and afflicting themselves so that others may see the shining heaps — 
yellow or white, as you please— extracted from mother earth, which the 
poor slaves of wealth have raked into their individual comers. 

Many other objects which act as causes there are with which we need 
not deal. But one evokes our s)rmpathy — ^the desire to benefit others, 



212 OVERWORK AND UNREST, 

especially when this desire is coupled with, or proceeds from the fountain 
of Divine Love ; but those who are thus actuated, ought to seriously con- 
sider whether they cannot as well, or better, and longer, serve God while 
keeping in good repair the organism which He has entrusted to them, 
and that so it may last longer for His use and service. 

In contrasting old-time leisure with the rush attendant upon modern 
advancement, let me not be understood as ignoring the advantages in many 
respects which have accrued to us. Nor do I consider it necessary to 
debate the statement, that, " it is better to wear out, than to rust out" I 
hold that it is best not to do either more rapidly, or to a greater extent 
than is unavoidable. 

It might by some be deemed necessary to apologize for reading at a 
congress of learned sanitarians, some of the truisms I am about to ex- 
press ; but perhaps you will bear with me if I jot them down for the 
possible benefit of others — the young and thoughtless ; and besides, per- 
haps some of us who know these things are more apt to be doers of them 
if we put them down in black and white, in the same way as we have 
sometimes jotted down our New Year's resolutions. If the rest of you do 
not need these mnemonic aids to sanitary practice, then I must ask you 
to pardon my being led into this course by a weakness peculiar to myself. 

Let me first enumerate some remedies or precautions that are in the 
power of the individual. First of all, systematic alternation of work, rest, 
and recreation— devoting a certain number of hours to work, that number 
being less or greater according to the character and intensity of the work ; 
laying aside another portion for rest of body, others for recreation and 
feeding of body and mind, the amounts and characters to be varied to 
suit the kind and character of work performed by the individual. It 
provokes a smile of sadness when one hears the mechanic and laborer 
claiming exclusively for their own classes the name of " workingman," 
little knowing to what an extent the workingman whose brain does most 
of his professional work can sympathize with them, and unable to recipro- 
cate that s)rmpathy in the majority of cases. 

To go fully into details regarding the S3rstematic division of time above 
sketched out, would make this paper too long. The necessity for early 
and sufficient sleeping hours has already been alluded to. I would here 
add that sleeplessness and disturbed sleep are caused to some persons by 
working the brain up to bedtime, and leaving it in a stimulated condition 
on retiring. To such persons, some little recreation not requiring much 
thought will be a helpful precursor of their bedtime hours. Students, old 
and young, often give the excuse that they can do better work at night : 
the formation of such a habit is, as a rule, to be avoided. I have known 
students who, from childhood, have been able to study amid the conversa- 
tion of others in the family sitting-room, and just as well in the daytime 
as at night. Habit is very tyrannical, and should be watched when it 
attempts to assume the mastery. Afterwards it may, occasionally it may 
not, be overcome. 



OVERWORK AND UNREST, 213 

Mental unrest in the shape of worry and anxiety are powerful factors in 
disturbing the proper exercise of our functions, and producing slowly (or 
it may be, in rare instances, speedily) organic disease. Of this, the typical 
example is often seen in that best of created beings whom the Germans 
call "the house-mother." In cases of this kind we may call in our 
philosophical sayings about certain events being of "no importance a 
hundred years hence," " no use crying over spilled milk," etc.-^in short, 
the uselessness and senselessness of worrying; and furthermore, those 
who seek to do so may receive from the highest source a certain amount 
of rest — ^perhaps I should say the complete rest— of mind coming from 
the confidence of all being in a Father's hands. Let us try our best not 
to worry. 

I have known persons under the impression that very hard mental work 
might be carried on if the individual would counteract it by an increased 
amount of physical exercise — long walks, and violent exercise at foot-ball, 
lacrosse, etc. Now this is a method of similia similibus curantur that 
should not be advocated even by those who profess that dogma to the 
exclusion of all other means of cure; for the dose is too large. It is 
quite true that every portion of our organism — muscles as well as brain — 
should, by appropriate exercise, have development maintained; but we 
must guard carefully against using up an extra supply of nerve energy on 
muscle, at the very time that an unusual drain of nerve energy is going 
on in other directions — ^in memorizing, comparing, deducing, and other 
mental exercises. This remark is in line with the well known advice 
regarding using up the nervous supply while digestion is going on. 

In this connection I may throw out another warning, and I will do it 
most briefly, by stating that I never give a nerve tonic to a man who is 
habitually overworking his nervous system. Do not goad on the horse 
that is racing hard all day. First, decrease the work, or advise its 
decrease; and then give your nerve tonic, or nerve stimulant, for a 
temporary use and purpose. With a man who has a worthy object to 
serve in a very short time of overwork, the case is different ; although 
even then great caution is required. 

I may add that to alcoholic stimulation in such cases I am totally 
opposed — ^teetotally, if you like. I have seen many a fine intellect ruined 
by a mistaken course in this regard ; most of you have also seen such 
cases. 

I need not say much about making hard work of pleasure — ^which it 
then ceases to be : most of you have been to the World's Fair. All that 
the foolish ones of us can now do is to console ourselves with the 
supposition that we have been doing our duty from an educational stand- 
point. 

I may conclude my remarks about individual care and precautions by 
emphasizing the value of occasional abandonment of work, and the change 
of occupation — going off camping, etc. Even for people whose income 
will not allow them to abstain from all work, change of occupation will 



214 OVERWORK AND UNREST. 

often give a rest ; e» g., I have known laborers and mechanics go off and 
work on steamboats, cattle boats, surveys ; city laborers go to the harvest- 
field, and so on, with marked benefit 

My paper has grown longer than I expected, and in order to keep my 
promise, I must treat the subjects in which we may act collectively very 
briefly. 

There is one rest which is of very ancient origin, viz.^ every seventh 
day, now kept in most places, with which we have to do on the first day 
of the week. When the American Public Health Association met in 
Toronto a few years ago, a few of the members remained over Sunday. 
I need not remind them of the delightful rest of that day, which, I hope, 
consoled them for the little inconvenience in the matter of locomotion. 
We have had two battles in Toronto within the last two years by those 
who are anxious for Sunday cars, Sunday newspapers, Sunday saloons, 
and Sunday work in general ; but the cause of hygiene, the cause of the 
hard-worked toilers of six days in the week, was won by an immense 
majority, in the face of selfish designs and unscrupulous personation at 
the polls, which in this case there was no means of punishing or preventing. 

The cessation of labor at five o'clock is one of the victories of the last 
decade, and I hope it, or something similar, may be extended to other 
classes. During a visit to Boston two or three years ago, I was surprised 
and pleased to find that most of the business ceases between five and 
six p. m., Boston knowing how to take care of its brain. If the " Hub " 
can find time to slow up its revolutions, why should not the rest "of the 
universe " keep pace with it ? In some of the principal of the West India 
islands, in former days, business ceased in the middle of the afternoon. 
I do not know whether such is still the practice or not. 

One half holiday in the week for store-keeping employes is now in 
vogue in some of our cities, and I trust wherever an attempt is made to 
introduce it, our women will use not only their voices but their example 
in its behalf. 

In some places the attempt has been made to do away with the school 
recesses in the middle of the morning and afternoon sessions. This is a 
move in the wrong direction which requires to be watched. 

If, in any of my unfamiliar wanderings in the precincts of the stock- 
exchange, or in the domain of the psychologist, I have committed any 
technical errors, I must ask you to overlook them ; and, in conclusion, I 
hope I have not too far wearied you in this slight and disconnected 
contribution to the work of sanitary amelioration. 



XLIV. 

APUNTES SOBRE LA ESCARLATINA EN LA CIUDAD 
DE PUEBLA, MfiXICO. 

POR KL Dr. FRANCISCO MARIN, 
Puebla^ Mixico, 

En un periodo de mas de veinte y cinco ailos, y durante este tiempo, 
he observado que la escarlatina se presenta en dicha ciudad, con carac- 
t6res tan benignos, que habia llegado d creer que las formas graves, 
serfan desconocidas en esa localidad. 

Esta enfermedad aparece casi todos los ailos, en la prima vera, con 
manifestaciones tan atenuadas y d^biles, que si no fuera por una obser- 
yaci6n cuidadosa y atenta, podria pasar inadvertiva. Casi todas las enfer- 
medades infecciosas predominan en esa ^poca del ailo. 

Afecta d los individuos que componen las diversas categorias sociales, 
y me parece que predomina en la rasa blanca. Los niilos la adquieren 
de preferencia m^nos los que jovenes y es rara en los adultos. Se observa 
poco en los pobres, pues solicitan rara vez los auxilios del medico, y 
por lo mismo este pequeno estudio se refiere de preferencia k la escarla- 
tina en las personas mas 6 m^nos acomodadas. 

Asf es que predominando en la primavera, esta exantema febril se 
propaga con facilidad, sobre todo entre los niilos, pues no se toman las 
precauciones indispensables para evitar el contagio. Los enfermitos per- 
manecen con su familia, los niilos se comunican entre sf, como de cos- 
tumbre ; facilitdndose de esta manera la propagaci6n de la enfermedad 
y haci^ndose el contagio, por decirlo asf, necesario, y son afectados 
todos los individuos que no la ban ten/do anteriormente. 

Tal vez k esta circunstancia se deba el que se observe rara vez en los 
adultos ; puesto que la mayor parte de estos, ban sido atacados durante 
su niilez. Esta es tal vez una circunstancia favorable, porque he obser- 
vado que la escarlatina era tanto mas suave y benigna, d medida que los 
individuos afectados, tenian una edad menor, siendo ap^nas una ligera 
indisposici6n en los niilos de pecho. 

La forma que en general reviste las escarlatina, en nuestra capital del 
Estado, es la que los autores clasifican bajo el nombre de benigna, la 
que estd caracterizada por la poca intensidad de la fiebre, por su dura- 
ci<Sn corta, por una erupci6n moderada acompailada de una faringitis 
no muy intensa, y en cuya evoluci6n no se presentan accidentes graves. 
En muchas ocasiones, se observa que la enfermedad toma una forma 
incompleta, 6 como dirfa el celebre Trousseau '* fustra." Esta es muy fre- 
cuente, en ella domina el malestar de la garganta debido d una farin- 
gitis ligera, acompailada de la erupci6n puntillada caracterfstica, la cual 



2l6 ESCARLATINA EN LA CIUDAD DE PUEBLA, 

ap^nas se marca en algunos lugares del cuerpo, como en el pecho y 
principalmente al nivel de los codos. Cast todos estos enfermos no hacen 
cama, continuando su vida ordinaria. Algunos tienen fiebre ligera per 
tres <S cuatro dias, al cabo de los cuales cesan los sfntomas agudos y se 
presenta el periodo de descamaci6n. Tambi^n esta varia en intensidad, 
no siendo rara que en los casos ligeros, la descamaci6n epid^mica sea 
abundante. 

Muy pocas veces la escarlatina se complica de nefritis albuminosa 6 
de accidentes difler6edes <S sea pseudo diflerfa. Respecto d la primera 
de estas complicaciones, he visto que el mal no se hace cr<Snico, sino que 
desaparece en pocos dias y una 6 dos veces tan solo he encontrado acci- 
dentes ur^micas. La angina algunas veces toma el aspecto pultaceo- 
membranoso ; pero la misma facilidad con que desaparece, nos pneba 
que estd muy distante de la difterfa. Esta complicaci6n produce siem- 
pre la alarma de las familias ; pero la presencia de la erupci<Sn escarlati- 
nosa nos ha dado siempre confianza en obtener un buen resultado. 

La difterfa existe con toda su gravedad acostumbrada, siendo la pre- 
sencia de la escarlatina una predisposici<Sn para adquirirla ; pero cutndo 
esta enfermedad se presenta, reconoce causas muy especiales, que fivo- 
recen y acrecientan la virulencia de su microbio, y d las que la ma/or 
parte de los escarlatinosas no estan expuestos. Para mi son enferoe- 
dades muy distintas, que alguna vez se encuentran reunidas en el mistno 
Individuo y producidas por dos ihfecciones diversas ; la de la escarlatina 
y la del microbio de LoefRer. Pocas veces, el reumatismo aparece des- 
pu^s de la escarlatina, sin embargo he visto casos de estas que han sido 
complicados mas tarde de accidentes coreicas. 

La mortalidad es casi nula, pues en tan largo tiempo y en un niimero 
considerable de enfermos, mis recuerdos no son, sino de dos 6 tres casos, 
mortales. 

Por lo tanto, podemos decir, que comparada esta enfermedad con la 
manera con que aparece en otras paises, en la ciudad de Puebia es una 
enfermedad relativamente benigna y suave. 

En este afio, por disgracia, ha existido una epidemia de escarlatina en 
casi toda la Reptiblica. Hemos ten/do una verdadera epidemia, princi- 
palmente en las meses de Abril, Mayo, y Junio. En nuestra ciudad 
tom6 6 asumi6 formas mucho mas intensas que las que teniamos costum- 
bre de observar. Desde luego el cardcter epid^mico se hizo sentir, por la 
exageraci6n de los sfntomas, y por la propagacion mas rdpida. Todas 
las manifestaciones de la enfermedad se acentuaron ; asf es que la fiebre 
fu^ mas intensa y de mayor duraci6n, la erupci<Sn mas generalizada y 
abundante, invadiendo todo el cuerpo, la faringitis mucho mas intensa y 
dolorosa. En fin, la escarlatina se present6 con su cuadro clfnico habi- 
tual, apareciendo con cierto aspecto de gravedad. Y sin embargo, no 
lleg6 a ser aquella enfermedad, que en otras paises y lugares, destruye 
tantas vidas ; supuesto que en los registros del estado civil, el niimero 
de defimciones fu^ insignificante con relaci6n d lo que podfa esperarse, 
atendido el genio epid^mico que la enfermedad habia tornado. Se 



ESCARLATINA EN LA CIUDAD DE PUEBLA, 21*J 

puede asegurar sin temor de equivocarse, que las defunciones iueron 
debidas d la falta de ciudados, 6 d las medicaciones irracionales, con las 
que el pueblo bajo atiende d sus enfermos. For mi parte puedo afirmar 
que en mi prdctica particular, no tuve ningun caso desgraciado. 

A g^andes rasgos he tratado de dar una idea de lo que es la escarlatina 
en mi localidad, y creo necesario entrar en algunas consideraciones que 
pueden ser de interns. 

^' A que condiciones se debe la benignidad de la escarlatina, en aquella 
ciudad ? 

£n primer lugar debemos conocer las condiciones higi^nicas que natu- 
ralmente posee la ciudad de Puebla. Enumerare algunas de las princi- 
pales. Su clima benigno, la gran claridad de su atm6sfera luminosa, su 
temperatura casi uniforme no sujeta d enfriamentos bruscas, d la poca 
humedad de su aire, d la perfecta orientaci6n de sus calles, d la amplitud 
de sus habitaciones, d su agua abundante y bien distribuida, d su declive 
que facilita su drenaje y la limpieza general de la ciudad, sobretado en 
tiempo de lluvias, d sus aguas sulfurosas, y d la proverbial limpieza de 
sus habitantes. En segundo lugar, muchas enfermedades infecciosas 6 no 
existen 6 son muy raras en la mesa central. La fiebre amarilla cuyo 
foco lo tenemos tan pr6ximo, nunca nos invade, el carb6n nos es des- 
conocido. La fiebre tifoidea reviste formas benignas € incompletas ; no , 
ataca d los ind^genas. La escarlatina y el zarampi6n existen mitigados. 
Es probable que los agentes microbidticos que determinan estas enferme- 
dades, mitigan su virulencia, se debilitan al encontrarse d tan gran 
altura, en medio de un aire enrarecido y circumdados de tanta luz. La 
ciudad de Puebla estd d 2,100 metros sobre el nivel del mar. For 
ultimo, comunicdndose fdcilmente la escarlatina entre los niilos, es 
muy probable que los adultos no presentan las formas graves que les son 
habituales porque casi todos ban tenido la enfermedad durante la nifiez. 

Tal vez sea una ilusi6n lo que me tomo la libertad de decir, sin 
embargo de que creo tener la comprobaci6n de los hechos. Exp<Sngase 
al contagio escarlatinoso, en las ^pocas en que la escarlatina se presente 
benigna, d los niilos que tienen que vivir en otros paises 6 lugares, con 
el objeto de obtener una especie de vacunaci6n, que les impida contraer 
una escarlatina grave. Yo he dejado d algunos nifios expuestos al 
contagio de la escarlatina, cuando estaban en las condiciones anterior- 
mente dichos, sin que esta prdctica me haya dado malos resultados. Los 
niSios ban contraido una escarlatina benigna y sin accidentes. 

Un hecho importante que observe en esta liltima epidemia es el 
siguiente. Se sabe y todos son de opini6n que la escarlatina no reincide, 
de que un ataque es preventivo para otro. Pues bien, observe que las 
madres que amamanta d niilos escarlatinosos estdn sujetas, en su mayor 
parte, d esta reincidencia, aiin cuando hayan tenido anteriormente un 
ataque de escarlatina bastante intenso. De cuatro seiloras en estas con- 
diciones, he visto d tres de ellas tomar de nuevo la enfermedad, por. 
cierto muy benigna pero con todos sus caract^res y terminar por su 
de8camaci<Sn particular. 



XLV. 
LOS EJERaCIOS FISICOS: LA HIGIENE. 

PoR KL Dr. EDUARDO R. GARCIA, 

Teniente Coronel del Cuerpo de Sanidad Militar, Profesor de Cirujia en 

LA EscuELA PrActica M^dico-Militar, Miembro de la Academia de 

Medicina y Delegado POR el Estado de Tabasco a los 

CONGRESOS DE WASHINGTON, ROMA, V CHICAGO, 
Mixico, 

En consonancia con el acertado precepto de la Asociaci6n Americana 
de Salubridad Publica, de que los trabajos que d ella se presenten ban de 
tener precisamente cardcter prdctico, tengo la bonra de presentar al 
importante Cong^eso que se reune en esta ciudad, un pequeilo trabajo, 
esencialmente prdctico y cuya mira es que de una vez para siempre, la 
bigiene sea la que norme los ejercicios f/sicos que indispensablemente 
ban de ejecutar todos los ninos que asisten d la escuela. Y como en este 
pais, todos 6 la g^an mayorfa van d las aulas y en las demas naciones 
del continente de Colon, las leyes respectivas piden que todos vayan d la 
escuela, es claro que la medida que voy d proponer no solo es prdctica y 
necesaria, sino que ataile d la totalidad de la nifiez de America, que 
boy naciendo d la vida, mafiana serd robusta juventud, para ser despu^s 
litil virilidad y al fin bonrada vejez. 

Sabido es que en la actualidad, hay acuerdo unanime respecto de que 
forme parte inseparable de la educaci6n bien comprendida la cultura 
ffsica ; pero si en esto bay acuerdo, no asi en los medios que se ponen en 
prdctica para conseguir fin tan deseado. La mayorfa opina (y por lo 
mismo manda poner en prdctica) que la cultura f/sica debe conseguirse 
por medio de los ejercicios gimndsticos. Mas un pequefio niimero de 
personas, y entre ellas yo, no opinamos de la misma manera. En efecto, 
si con los ejercicios gimndsticos se alcanza el objeto deseado, raz6n prin- 
cipal en que apoyan sus partidarios para seguirlos sosteniendo y practi- 
cando, no quiere decir esto que no baya otro medio que alcanzando igual- 
mente el fin sea notoriamente superior en calidad y en cantidad d dichos 
ejercicios. Este medio no es otro, que el de fracticar metodicamente 
todos losjuegos infantiles al aire libre. 

La rigurosa comparaci6n entre dmbos medios, bard resaltar indefecti- 
blemente las ventajas del que propongo sobre el que se practtca habi- 
tual mente. 

Para demostrar que le es superior en cantidad, bastard formular una 
sencilla reflexi6n al alcanze de todos los que hayan profesado esta mate- 



LOS EJERCICIOS FISICOS: LA HIGIENE. 21 p 

ria. En efecto, cuando un profesor hace ejecutar d un g^upo de nifios 
determinados ejercicios gimndsticos tiene que suponer (pues de otra 
manera no podrfa practicar su ensenanza) que todos los niiios tienen los 
mismos caract^res f/sicos, y por eso su enseilanza es ig^al para todos. 
Pero si esto supone el maestro y es guiado en los ejercicios solo por su 
conciencia y su saber, en los niilos pasa cosa muy diversa k lo que ^1 
desea y procura. Por homogenio que sea un g^upo, la observaci6n 
patentiza que fisicamente se divide en tres secciones : uno que tienen el 
desarrollo proporcional k su edad y condiciones, otros de mayor y otros 
en fin de menor desarrollo. Siendo el ejercicio igual para todos, claro 
es que solo aprovecha al grupo medio, siendo deficiente para el primero 
y excesivo para el Ultimo. De aquf se infiere que este modo de proceder 
favorece al menor niimero, y es inefifcaz 6 perjudicial para todos los 
demas. No sucederd lo mismo con los juegos libres^ porque en estos 
cada niilo teniendo por criterio su propia conciencia, aumentard 6 dis- 
minuird el ejercicio en consonancia con el alcanze de su fuerza ffsica, y 
como esto lo hace la totalidad de los nifios todos resultan beneficiados ; 
luego es obvio comprender que, en cantidad, son superiores las juegos 
libres d los ejercicios gimndsticos. 

£s todavfa mas claro, si posible fuera, demostrar que en calidad les son 
infinitamente superiores. Todos saben, que en materia de enseilanza, el 
aprendizaje y el beneficio que de ello resulta, son proporcionales al 
placer recibido en el acto de aprender. Pues bien, todos ban podido 
convencerse por la prdctica, que los ejercicios gimndsticos siendo en su 
mayor parte mon6tonos, solo despiertan interns al principio, y en seguida 
la mayorfa de ellos Uega d ser fastidiosa. Todo lo contrario pasa con los 
juegos libres^ pues no teniendo trabas, y sf mucho de expontaneidad, y 
por ultimo siendo por decirlo asf siempre variados, despiertan interns y 
estimulan ag^adablemente, de aquf el mayor beneficio recibido con igual- 
dad de esfuerzo productor; luego tenemos que convenir en que los 
juegos libres^ son superiores en cantidad y en calidad d los ejercicios 
gimndsticos. 

Si d esto agregamos que \o% juegos libres^ en la mayoria de los casos, 
simulan el modo de satisfacer las necesidades prdcticas, en tanto que los 
ejercicios gimndsticos solo en la minorfa alcanzan este objeto, tenemos 
que llegar d este consejo prdctico, plenamente sancionado por la higiene : 
en las escuelas primarias deben substituirse los ejercicios gimndsticos, 
con la prdctica metddica de las juegos libres. 



XLVI. 

LOS GARROS DORMITORIOS NO LLEMAN LAS CON- 
DICIONES QUE LA HIGIENE EXIGE. 

POR EL Dr. FERNANDO TARRAGA, 

Delegado del Estado db Dorango Mexico, 

Mixico^ Mix, 

Vengo d tratar, seiiores, un pequeiio punto de higiene, pero que interesa 
en sumo grado, asf d este pueblo viajero per excelencia, como d mi pais en 
donde las comunicaciones ferrocarrileras van siendo fdciles y frecuentes. 

El hombre que viaja, hdgalo de lamanera que lo hiciere, sufre un 
movimiento constante que conmueve su sistema todo y que le hace indis- 
pensable el descanso para reparar sus fuerzas. Y como quiera que la 
urgencia de los negocios lo obligan d aprovechar la noche para recorrer 
largas distancias ; desde que las comunicaciones terrestres fueron exten- 
sas por la via ferrocarrilera, naci6 la necesidad del carro de dormir. Y 
bien que para el infeliz que viaja en 3* 6 para el de mediana posicidn que 
lo hace en 2* atin no exista tal comodidad, para aquellos d quienes su 
fortuna les permite pagar un pasaje caro, existe un medio de descanso ina- 
preciable. En vez de la eterna noche llena de molestias y fatigas, el 
descanso pldcido ; en lugar de la agitaci6n, la calma ; en lugar de la 
pena, el placer. La horas trascurren veloces y al despertar, encuentra 
uno : largas distancias recorridas durante su sueilo, bienestar en su orga- 
nismo que repar6 sus fuerzas, dando lugar d los cambios qufmico-fisio- 
16gicos del sistema muscular; y en virtud de esto buen humor, sem- 
blante placentero, disposici6n para contemplar los cuadros visueilos del 
paisaje y resistencia para las nuevas fatigas del dia que comienza. 

Pero I Ay ! ^ De que servirdn tantas ventajas, si en el lugar del des- 
canso encuentra el pasajero el g^rmen de la enfermedad y quizds de la 
muerte? En la cama en que el duerme hoy, durmi6 anoche el tuber- 
culoso ; en los paredes de una cama superior, en los colchones, en los 
almohadones en las mantas quedaron los esputos de tal enfermo ; y esas 
paredes y esas colchones y esas cobertores quedardn allf dias y noches 
durante largos viajes sin sufrir una limpieza capaz de destruir los baci- 
los engendradores del mal. Pasardn por el lecho contaminado los fuer- 
tes y los d^biles, los robustos y los endebles, resistirdn los primeros, 
pero sucumbirdn los otros y habrdn comprado unas horas de descanso al 
precio de una enfermedad incurable y que en breve los conducird al 
sepulcro. Habrdn hecho el negocio de Esau vendiendo su progenitura 
por un plato de lentejas. 



LOS DEFECTOS DE LOS CARROS DORMITORIOS, 221 

No se diga, seiiores, que teorizo. Hoy es un hecho bien averiguado 
que la tubercul68i8 es una enfermedad trasmisible, que su g^rmen, el bacil- 
lus tuberculosus^ es mas peligroso cuando se desecan los esputos y se 
mezclan estas partfculas con los g^rmenes del aire que respiramos. 
Ahora bien, yo he podido ver en esos carros dormitorios, personas que 
por su aspecto fifsico, por su tos incesante, por su abatimiento, no dejaban 
lugar d duda respecto de su mal. Tengo la evidencia de que una 
enferma tuberculosa en el ultimo periodo de su mal ha venido en uno de 
estos carros durante dos dias y esta enferma conocida por el Seiior Vice- 
presidente de esta junta, sucumb]6 dntes de un m^s en la capital de nues« 
tra Repiiblica. 

En el pueblo americano, por las noticias que yo he adquirido, es prc- 
sente este terrible mal. Nada tiene pues de extraiio que un tuberculoso 
atraviese de un punto k otro viajando en carro dormitorio. Viajar y sem- 
brar g^rmenes d su paso es todo uno, pues no hay en los carros de los 
viajeros un dep6sito para escupir. 

Es verdad que en estos carros diariamente se pone ropa limpia en las 
camas ; y suponiendo que el lavado y planchado sea suficiente para este- 
rilizarlas, quedan los cobertores que nunca se lavan y los colchones 
que tampoco sufren tal aseo, bastando para probarlo el que su aspecto y 
coloraci6n son de telos no lavados. 

Pero no es solo la tubercul6sis la que puede propagarse por los carros 
dormitorios. Bien sabido es en Mexico, que muchas personas que se 
sienten invadidas por el tifo, salen inmediatamente de la Capital para 
dirigirse k la ciudad de su residencia ; de donde se infiere que esas per- 
sonas han podido contaminar las camas ; pues aunque de un modo empf- 
rico pueda asegurarse que no es en este periodo cuando esa enfermedad 
es mas trasmisible, no por eso deja de ser cierto que no estando perfecta- 
mente estudiado el tifo, serfa una imprudencia magna ir d pemoctar al 
lugar en donde durmi6 el tifoso ; d ponerse en contacto con los mantos 
con que se cobijo la noche anterior ; d hundir su cabeza, d poner su boca 
y nariz en el almohadon donde se hundi6 la cabeza del tifoso, en donde 
arroj6 su aliento y en donde quiza tambi^n arroj6 su baba durante su 
letargo. Yo creo, seiiores, que ningun higienista, que ningun hombre 
que se preocupe por la salud publica podrfa ni consentir en esto, ni reco- 
mendarlo como bueno. 

Quedan aiin, seiiores, otras enfermedades trasmisibles, como el gran 
grupo de las tihas que se pueden atrapan en una noche de turismo. En 
verdad que estos males no son ni de 16jos de la importancia de los ante- 
riores y nosotros espfritus mascdlinos los juzgamos con cierta benevolen- 
cia. I Pero qu^ dirfa la mujer bella, prendada de su abundante cabellera 
y que forma uno de sus encantos, si le viniera el favus la ttna decal- 
vente y aquel atractivo se convirtiera en repugnancia? ^Qu6 dirfa si 
por haberse puesto en tal estado pierde un matrimonio ventajoso ? ^ (!) si 
siendo casada su marido se desvfa y busca fuera del hogar algo que no le 
cause asco ? 

Convengamos en esto, seiiores, los carros dormitorios tal como estdn 



222 LOS DEFECTOS DE LOS CARROS DORMITORIOS. 

constituidos pueden ser una fuente de pelig^os para la salud ptiblica por 
la propagaci6n de enfermedades trasmisibles. 

Pero el higienista no se preocupa de esto solo ; trata de que las enfer- 
medades no ataquen al g^nero humano y sean estos trasmisible 6 no. Y 
asf como penetra d la escuela y ev-ita por la buena luz, por la magnitud 
de las letras y por el color del papel, que la retina le fatigue, que la 
acomodaci6n se exajere y que el pueblo se vuelva miope ; asf tambi6n en 
un servicio pdblico debe preocuparse de la salud, tratarse 6 no de enfer- 
medades trasmisibles. 

Orinar y arrojar fuera el escremento, he allf dos necesidades iisiol6gicas 
imprescindibles. Los inconvenientes que trae consigo el no ejecutar estos 
desahogos son bien conocidos de Yds. i Quien no ha visto venir una oclu- 
8i6n intestinal 6 una pardlisis vesical por no haber dado complimiento k 
estas funciones ? En el carro dormitorio para arrojar la orina al exterior es 
preciso dejar el c6modo lecho, caliente y amoroso para exponerse d un 
enfriamento brusco, pues muchas veces en el momento en que uno se 
dirige d hacer esta evacuaci6n, el empleado abre la puerta del carro y 
se precipita d torrentes el viento frio del exterior causando neumonia, 
enfermedad que atrapada en estas circunstancias ha causado la muerte 
de dos de mis clientes. 

Suele suceder que el enfriamiento es del todo ini^til, pues encuentra 
uno cerrado el excusado y esta no se abrird hasta que el tren no se ponga 
en movimiento ; mi^ntras est^ en la estaci6n, no habrd lugar en donde 
defecar y si dura 466 horas, 466 boras durardn las angustias del que 
estd atormentado por los c61icos intestinales 6 por las contracciones de su 
vejiga. No se me diga que un tren nunca dura tan largas horas en una esta- 
ci6n. El tren de Pachuca en nuestra Repiiblica llegando d las dos de la 
maiiana d esta poblaci6n, permanece en la estacion dejando dormir al 
viajero hasta las ocho del siguiente dia. Es frecuente que un tren per- 
manezca unos 50 <S 60 minutos en una estaci6n, y si en las proximidades 
de estos grandes centros no se v^ esto, sf es frecuente d medida que se 
aleja de aquf y se avecina d la frontera mexicana. 

Suponed ahora que un viajero es un anciano prostdtico d quien le urge 
vaciar su vejiga ; si ese seilor no puede cumplir en aquel momento con su 
necesidad, no lo podrd en lo sucesivo y pasardn quizd 10 6 12 horas 
para llegar d un punto en donde encuentre persona hdbil que le practi- 
que el cateterismo ; teniendo quizd, que interrumpir un viaje, interrupt 
cion cuyas consecuencias solo el puede comprender. 

Queda pues establecido en 2^ lugar que en los carros dormitorios no 
siempre es posible orinar y defecar. 

I De qu^ maAera es pueden remediar estos inconvenientes ? 

Empecemos por lo liltimo : Es posible dotar d cada pasajero de una 
vasinica para que le sea facil evacuar la orina sin abandonar el lecho y 
sin exponerse d enfriamentos peligrosos. Bastard dar d cada recipiente 
una forma tal que el Ifquido no pueda vertirse, tal por ejemplo como la 
que se dd d ciertos tinteros en los cuales no es posible que se derrame 
ni una gota de Ifquido. 



LOS DEFECTOS DE LOS GARROS DORMITORIOS. 22^ 

Es posible que cada comun est^ dotado de un recipiente tal que 
impida que se ensucien las estacionee, y que pueda lavarse con gran can- 
tidad de agua despu^s, k fin de que los comunes se puedan usar mi^n- 
tras el tren no estd en marcha. 

Para evitar las enfermedades trasmisibles es indispensable que de una 
manera incondicional se exija de la 6 las companfas que tienen estofr 
carros, que despu^s de cada viaje se desinfecten colchones, almohadones, 
y cobertores entrando estos efectos k una estufa de vapor, que las camas 
altas se ventilen y que sus paredes sean cuidadosamente aseadas por 
medio de esponjas empapadas en 8oluci6n de bicloruro de mercurio, 
que se impida d los viajeros que escupan en otro lugar que en las escupi- 
deras, y que d los de los camas altas se les dote de un recipiente ade- 
cuado al objeto. Midntras no se llenen estas prescripciones no se podrd 
decir que los carros dormitorios son confortables, pues la i* condici6n 
del confort debe ser la salud. 



XLVII. 

LA GRIPA, SUS FORMAS Y COMPLICACIONES EN 
ORIZABA— SU PROFILAXIA. 

POR EL De. gregorio mendizabal, 

Orizaba^ Mix, 

Animado en los mejores deseos de contribuir, aunque en la mfnima 
escala que me es permitido, al engrandecimiento de las ciencias m^icas 
en el Continente Columbino, y queriendo d la vez corresponder k la con- 
fianza que en mi ha depositado el Gobierao del Estado de Veracruz 
(Mexico) , nombrdndome su delegado en el Congreso de Higtenistas que 
debe reunirse en Chicago el 9 del pr6ximo mes de Octubre, tengo la 
honra de presentar d dicho Cong^eso las siguientes observaciones, que 
serdn un humilde contingente sin duda ; pero no desnudas en lo absoluto 
de valor, ya por tratarse de una enfermedad que de algunos ailos k esta 
parte constituye un verdadero azote de la humanidad, ya por ser estas 
observaciones recogidas con tanta minuciosidad, que abrigo la preten8i6n 
serverdn como elemento de importancia para formar la historia de esta 
pandemia. 

Me refiero y voy d ocuparme de la gripa 6 influenza, que recorre sin 
cesar el mundo de cinco 6 seis anos d esta parte, causando grandes estra- 
gas en sus moradores, elevando en algunos lugares notablemente la cifra 
de la mortalidad y lo que es peor aiin, sin causar grande alarma, sin sem- 
brar el pdnico, como el c61era morbus por ejemplo 6 la peste de Oriente 
y sin despertar en el mundo cientffico el interns que debiera, para oponer 
un dique d sus reiteradas invasiones, aniquilarla, si posible fuera y librar 
asf al g^nero humano de esta nueva plaga que lo diezma sin escdndolo y 
suele dejar en precaria situaci6n d muchas de sus innumerables victimas d 
quienes no logra privar de la vida. 

Para la mejor inteligencia de lo que voy d exponer, debo comenzar por 
decir aunque sea unas cuantas palabras acerca de la situaci6n topo- 
grdfica de Orizaba, su climatologfa, higiene, niimero de habitantes, mor- 
talidad, enfermedades reinantes y de cuanto pueda contribuir, en una 
palabra, d formarse una idea de las principales condiciones que puedan 
ejercer una influencia marcada en el modo de ser de esta enfermedad 
en aquellas comarcas. 

Orizaba, una de las ciudades mas importantes del estado de Veracruz 
(Mexico), tiene en la actualidad 45,000 habitantes, se halla d 1,236 
metros sobre el nivel del mar, se encientra situada en una de las gigantes- 
cas vertientes orientales que tiene por ndcleo el Citlaltepetl 6 sea el Pico 



LA GRIP A EN ORIZABA. 225 

de Orizaba, de la gran cordillera que forman las elevadas montafias, que 
en Mexico se conocen con el nombre de Sierra Madre. Estd compren- 
dida entre los 18*" 50' y 54" de latitud North y las 2° i' y 54" de longitud 
Este de Mexico. Dista 104,260 metros de las costas del Golfo de 
Mexico y la declinaci6n de la aguja magn^tica es de 6° 25' Este. 

Los vientos que dominan en la ciudad son el N. E., alternando 
durante el inviemo y la primavera con el S. O., viento impetuoso, hura- 
canado, y seco, que enrarece notablemente la atm6sfera y deseca con- 
venientemente las habitaciones y el aire, que son allf muy hiimedos. 

Al N. E. de la ciudad hay varios pantanos que van despareciendo 
g^adualmente, ya por el mejor cultivo en la tierra, ya por haberse ido 
canalizando. La temperatura media de Orizaba es de 21^ cent/grados. 
Caen por t^rmino medio al aiio 2,500 milimetros de agua. 

La mortalidad en los liltimos atlos ha sido de 25 por mil y las enferme- 
dades dominates han sido las inflamaciones gastro-intestinales y la tuber- 
cul6sis en sus diversas formas. 

No es Orizaba de las poblaciones que puedan llamarse propiamente 
palustres y de tiempo inmemorial han reinado allf las fiebres intermi- 
tentes 6 de quinina, pero sin gravedad notable y sin presentarse bajo 
forma end^mica, ni m^nos epid^mica hasta el ailo de 1867, en que con 
motivo de la gran remoci6n de tierras que se hizo, al abrirse la brecha del 
Ferrocarril Mexicano, se desarroll6 un impaludismo agudo que dur6 ha- 
ciendo estragos en la ciudad y sus alrededores por espacio de ocho 6 diez 
aiios afectando formas graves, tanto agudas como cr6nicas y presentdn- 
dose sin interrupcidn ailo tras ailo, comunmente como endemo-epidemia. 

Gracias al desecamiente de los pantanos por canalizaci6n y al incre- 
mento que ha tomado el cultivo de la tierra^ asf como al grado mayor de 
civilizaci6n que han alcanzado los habitantes, las fiebres teltiricas han 
perdido en la actual idad su cardcter agudo ; pero si acompatlan, disfrazan 
y complican d la mayor parte de las enfermedades 6 las imprimen por lo 
m6nos un tipo 6 cardcter especial, que exige como adjuvante y d veces 
como agente terap^utico especial y her6ico, la quinina. 

Las condiciones higi^nicas de la ciudad dejan verdaderamente mucho 
que desear. Es rica en ag^a potable ; pero en tiempo de lluvias viene 
esta muy cargada de detritus orgdnicas, que la hacen malsana cuando no 
se depura convenientemente y origina frecuentes enfermedades gastro- 
intestinales. 

La situaci6n topogrdfica en un valle inclinado, permite el escurri- 
miento fdcil de las aguas de lluviay de todos los desechos de la ciudad ; 
pero sus calles son estrechas, sus empedrados incompletos y descuidados 
y de ocho aiios d esta parte se han comenzado d construir atarjeas, que no 
se ajustan d las condiciones que reclama la buena higiene y se van con- 
stituyendo en focos de enfermedades infecciosas, dntes poco conocidas, 
como el tifo exantem^tico, que de ent6nces acd viene apareciendo end^- 
micamente en las estaciones de verano. 

Las casas en lo general son hiimedas por falta de canalizaci6n del sub- 
suelo : dntes eran amplias y bien ventiladas y sus patios espaciosos con- 



226 LA GRIPA EN ORIZABA, 

vertidos en jardines ; hoy que ha aumentado notablemente la poblaci6n, 
d la par que la avaricia de los propietarios, se construyen mas secas, 
pero en cambio, reduciendo la capacidad de las habitaciones y la ampli- 
tud de las patios, lo que las hace malsanas y propias para facilitar la 
difusi6n de los g^rmenes de enfermedades infecciosas. 

Las costumbres de los habitantes son en lo general morigeradas ; la 
vida es relativamente cara, pero no hay miseria ; las gentes se nutren 
bien y son generalmente aseadas. La embriaguez en todas las clases de 
la sociedad se ha estendido desgraciadamente, engendrando esa miseria 
fisiol6gica que predispone d todo g^nero de enfermermedades, cuando no 
mata con los accidentes miiltiples que ella determina. 

Antes del advenimiente de la primera linea ferrocarrilera, dntes del 
ailo de 1867, nuestros bosques poblados de drboles seculares, daban 
cierta normalidad d las estaciones ; pero tanto la construcci6n de dichas 
vias ferreas como el combustible requerido para su explotaci6n, han 
hecho sufrir d estos bosques una tala tan inmoderada y excesiva, que ya 
comenzamos d sentir sus efectos. Antes las lluvias eran, como de cos- 
tumbre en los paises montanosos, frecuentes, pero bien distribuidas. 
Hoy escasean muchos aiios 6 caen bajo forma torrencial, arrastrando 
cuanto encuentran d su paso, inclusive la capa de humus que hace fi^rtiles 
nuestras tierras y asolando comarcas enteras. Los estfos son largos y 
excesivos, que dntes eran moderados por una caida prematura de las 
lluvias ; los inviernos, dntes benignos y cortos se vienen haciendo cada 
vez mas exagerados, hasta el grado de ser ya frecuentes las escarchas y 
aun las heladas y la tierra, dntes sombrada por las nubes que entolda- 
Ian nuestro cielo, recibe por mas tiempo los rayos ardientes del sol, que 
debilitan, si no aniquilan los g^rmenes de la vegetaci6n. 

« 
« « 

Conocidos estos datos, voy d decir en pocas palabras, desde cuando 
apareci6 en Orizaba la influenza bajo la forma epid^mica, el numero de 
invasiones que ha hecho, sus formas, gravedad, mortalidad y dir^ tarn- 
bi^n algo sobre el tratamiento por nosotros seguido y los medios profildc- 
ticos, cuya eficacia nos ha sido sancionada por la experiencia. 

La influenza dej6 de ser en Orizaba por primera vez, una de tantas 
endemias de fiebres catarrales, que nos visitaban frecuentemente en el 
invierno, d principios del ano de 1890. 

En Febrero de dicho ano despu^s de haber recorrido la Europa, hizo 
entre nosotros su primera incursi6n ; dur6 mas de dos meses y fu6 sin 
duda una de las que mas estragos caus6. 

En Diciembre del mismo ano apareci6 por segunda vez y dur6 todo el 
invierno, terminando en Marzo del aiio de 1S91. 

Su tercera invasi6n la hizo en Enero de 1892 y termin6 d fines de 
Marzo y la ultima vez que nos visit6 fu6 d principios de Febrero del pre- 
sente aiio, terminando en Abril. 

La duraci6n media de las distintas epidemias ha sido de tres meses y 



LA GRIP A EN ORIZABA, 227 

las mas cortas, como las de '90 y '92 fueron las que revistieron cardcter 
grave* 

Cuando han coincidido las epidemias con la ^poca en que reinan los 
vientos impetuosos del S. O., que son secos y ardientes y hacen bajar 
muy sensiblemente el bardmetro, eran mas graves los casos que durante 
ellas se registraban. 

En todas las epidemias los ninos han sido casi respetados y solo afecta- 
ban en ellos las formas catarrales mas benignas. 

Hemos tenido todas las formas que reviste en Europa ; pero modifica- 
das por la localidad y por lb comun m^nos graves. 

Han dominado las formas tordcicas mas 6 m^nos mezcladas con la 
nerviosa y la gastro-intestinal y algunas veces, aunque con poca frecuen- 
cia, estas dos Ultimas formas aislados. 

Como caract^res particulares de la influenza en todas sus formas, las 
mas acentuados han sido siempre la brusquedad del principio, la suma 
postraci6n de los enfermos, los dolores en las 6rbitas, localizados bajo 
las globos oculares, la hiperestesia general, la raquialgfa insoporta- 
ble, los dolores en todo el cuerpo que impedfan d los enfermos 
todo movimiento. Las convalescencias eran largas y d veces ma- 
yores que la enfermedad misma ; era notable el estado de depresidn, 
tanto en las fuerzas fisicas como en la energfa moral ^ intelectual en que 
quedaban los atacados. En las formas francamente nerviosas, el insom- 
nio, las alucinaciones, el delirio consciente y el cortejo de sintomas que 
acusan la profunda ]mpresi6n que recibe el sistema nervioso, cuando el 
organismo es presa de los g^rmenes de toda enfermedad infecciosa. Las 
formas tordcicas que dominaron durante todas las epidemias de influenza 
se nos presentaron bajo todas sus faces, desde el catarro simple, la larin- 
gitis J la traqueitis, hasta la bronco-neumonfa masiva psuedo-lobar y la 
verdadera neumonfa erupal, aunque poco frecuente esta liltima. 

Las bronquitis revestian las mismas particularidades que en Europa, 
persistencia de la tos durante muchos dias y aun meses despu^s de pa- 
sado el ataque y rebeldfa d todo tratamiento. 

En las neumonfas, que dieron el mayor contingente d la mortalidad, 
siendo normalmente raras en Orizaba, dominaban los fen6menos conges- 
tivos ; el calosfrio inicial era poco intenso, ligero el dolor de costado, los 
estertores eran mas bien sub-crepitantes que crepitantes, los esputos eran 
poco terlidos y muy viscosos, la dispn^a intensa y sin relaci6n muchas 
veces con la amplitud de la zona inflamada. La asfixia inminente oca- 
sionaba con frecuencia la muerte. 

Las pluresfas se presentaron con poca frecuencia : fueron siempre 
secas 6 sero-fibrinosas y rarfsima vez purulentas, mortales siempre d 
pesar de la intervenci6n quirdrgica oportuna. 

Todas las formas tordcicas, pero muy especialmente la br6nquica y la 
neum6nica, sirvieron d menudo de reactivo para descubrir tubercul6sis 
latentes, imprimi^ndoles no pocas ocasiones una marcha galopante 6 
haciendo por lo m^nos progresar muy sensiblemente la enfermedad. 

En los cardi6patas, Brighticos y neum6patas todas las formas bronco- 



228 LA GRIPA EN ORIZABA, 

pulmonares fueron siempre muy graves. Los primeros sobre todo, si 
no sucumbian d causa de algiin accidente asistdlico rdpido, se agpnavaban 
considerablemente, d causa del trabajo excesivo que el coraz6n se veia 
obligado d hacer por el obstdculo que encontraba la circulaci6n de la 
sangre en los 6rganos respiratonos. 

Muchas afecciones cardiacas que habfan quedado ignoradas, aparecieron 
despu^s de la gripa en personas que aprentaban gozar de cabal salud. 
£1 vulgo, y no solo el vulgo, las ha atribuido al uso de la antipirina. 

^'Sirvi6 aqui tambi^n de reactivo la gripa, como en la tuberculosis, 
para hacer ostensibles enfermedades latentes, 6 fueron estas el resultado 
de miocarditis y endocarditis determinadas por la influenza, como per 
cualquiera otra enfermedad infecciosa ? 

Yo creo que dmbos cosas son posibles, porque tengo la seguridad de 
que en algunos casos no habfa antecedente alguno de lesidn cardiaca pre- 
existente. 

En las dos ocasiones que la gripa se present6 en Orizaba en los meses 
de primavera, y hay que advertir que la primavera se inicia en Orizaba 
d principios de Febrero, afect6 la forma gastro-intestinal y no solo como 
complicaci<5n accesoria, sino con caract^res de tal manera agudos, que 
gobernaba, digamos as/, la evoluci6n clfnica de la enfermedad. No era 
simplemente el estado saburral, con la lingua seca, blanca en el centro y 
roja en los hordes, anorexia, etc. ; sino con v6mitos biliosos, dolores 
gdstricos, c61icos intestinales, diarrea intensa y algunas veces las deyec- 
ciones tenfan el aspecto risiforme que caracteriza las colerinas. Estas 
formas dieron tambi^n un contingente no despreciable d la mortalidad. 

Como manifestaciones cutdneas de la gripa, vf varios casos, sobre todo 
durante la epidemia que rein6 del '90 al '91, presentarse con manchas 
sarampionosas (y no habfa ent6nces sarampi6n en la ciudad, ni lo hubo 
tampoco una vez pasada la epidemia) y estos casos, acompafiados de 
fiiertes dolores en las rodillas, me hicieron recordar el dengue, con el 
cual tiene sin duda la influenza un pr6ximo parentescos no8ol6gico, al 
grado que no ha faltado quien diga que la gripa es el dengue de las paises 
septentrionales, como el dengue es la gripa de los paises cdlidos. Estos 
casos revistieron siempre notable benignidad. 

Dos veces vf la gripa determinar el aborto en personas que no tenfan 
otro motivo ni tenian predisposici6n d d, y cuatro ocasiones despertar 
accidentes s^pticos puerperales, que revistieron gravedad, aunque nin- 
guno origin6 la muerte. 

La influenza en Orizaba no present6 las marcadas tendencias d las 
recaidas que en Europa, d pesar de las imprudencias cometidas por los 
enfermos ; pero en los casos en que ocurrfan cambiaban frecuentemente 
de forma, como observa Jaccond. 

En las epidemias de primavera solfan los casos de influenza revestir 
formas que denunciaban complicaci6n con el paludismo, como la de una 
remitente tifoidea y otras veces venfan acompanadas de perturbaciones no 
febriles en las funciones del organismo, que se presentaban peri6dica- 
mente, sin llegar d la forma perniciosa, pero si la larvada, que cedian 



LA GRIFA EN ORIZABA. 229 

fdcilmente d la quinina, como sudores profusos, agitamiento profundo, 
neuralgias variadas, meteorregias, etc. 

Estas complicaciones eran raras, porque he podido observar que en las 
^pocas en que se ha presentado la influenza, la intoxicaci6n teliirica no 
ha tenido importancia alguna, lo cual probablemente era debido k la 
estacidn en que casi siempre aparecfa, el inviemo, ^poca en que desapa- 
recen por completo las manifestaciones del telurismo. 

La influenza ha doblado 6 aumentado una tercera parte por lo m^nos, 
la mortalidad en Orizaba durante los meses en que ha reinado. 

Una casualidad me hizo descubrir que en el seno de alguna familia, 
donde la gripa hizo mayores estragos y afect6 las formas mas graves, uno 
de los miembros de elLa, que tomaba habitualmente arseniate de estric- 
nina con motivo de un padecimiento pulmonar que son como sabemos, 
los que mas predisponen, y dan mayor gravedad d la gripa, qued6 
indemne y la pas6 de una manera tan benigna, que pas6 casi desaperci- 
bida. Esto me hizo poner atenci6n en las epidemias subsecuentes y \i 
que no habfa sido una mera coincidencia ; sino que en verdad, el ars6- 
nico 6 la estricnina 6 dmbas cosas reunidas, salvaban de la influenza 6 la 
atenuaban sensiblemente. 

Mas aiin : en las formas verdaderamente graves, en las neumonfas, por 
ejemplo, teniendo cuidado de injectar hipod^rmicamente, desde el prin- 
cipio de la enfermedad, el arseniato de estricnina d la dosis de 3, 4, 6 6 
miHgramos distribuidos en el dia, k la vez que el tratamiento sintomd- 
tivo debido, la marcha de la enfermedad sufrfa siempre modificaciones 
favorables bastante sensibles y al entrar el enfermo en convalescencia, con- 
tinuando el uso de esta preparaci6n por algiin tiempo, aquella era m^nos 
penosa, m^nos larga y mas libre de esa s^rie de accidentes neurast^nicos 
que deja siempre como huella la influenza. 

El vigor y las fuerzas agotadas renacen mas pronto, la energfa moral € 
intelectual despiertan mas temprano y los enfermos pueden volver al 
cabo de poco tiempo d sus ocupaciones habituales, sin esa serie de per- 
turbaciones del sistema nervioso vaso-motor que por meses enteros les 
molesta y aiin les inspira serias preocupaciones. 

He usado en algunos casos el ars^nico solo, y en otros, sola la estric- 
nina, y aunqne he encontrado siempre resultado favorable, nunca como 
cuando los he empleado asociados. Tal parece que el ars^nico obra 
directamente sobre los g^rmenes infecciosos de la enfermedad y la estric- 
nina sobre sus accidentes, d la vez que vigorizando el organismo y ddn- 
dole elementos de defensa contra las infecciones secundarias d que abre 
siempre paso la primitiva. El primero como antis^ptico; la segunda 
como el neurast^nico por excelencia, antis^ptica tambi^n, antifermente- 
cible, t6nico de las vias digestivas y sobre todo, t6nico de la tijnica mus- 
cular. En los casos complicados de paludismo siempre sacamos un gran 
partido de las inyecciones hipod^rmicas de biclorhidrato de quinina. 

Tal es d grandes rasgos, la historia de las epidemias de la influenza en 
Orizaba, que espero podrd ser de alguna utilidad d los que se prepongan 
hacer algUn dia la historia de sus invasiones en el mundo. 



230 LA GRIPA EN ORIZABA. 

No abrigo la preten8i6n de haber dicho nada que merezca la pena ; 
pero al presentar este conjunto de observaciones recogidas con escnipu- 
losidad y cuidado, abrigo la esperanza de que me conquistardn siquiera 
un humilde lugar entre los peones de la grande y humanitaria ciencia i 
que hemos consagrado nuestra vida y atestiguard mi deseo vehemente de 
cooperar, aunque con insig^ificante material, que utilizardn sin duda los 
genios que ocupan envidiable lugar en los escafios de esta notable asam- 
blea. 



XLVIIL 

LAS AGUAS POTABLES DE LOS CAMPOS PRESENTAN 
MUCHOS PELIGROS. 

POR EL Dr. angel GAVl5ro, 

PROFESOR ADJUNTO DE HiGIRNE Y CaTKDRAtICO DE BaCTERIOLOGIA EN LA 
ESCUELA DE MEDICINA DE MEXICO. 

Mexico. 

Senores : Es un hecho conocido, que en la mayor parte de los lugares 
habitados de la Repdblica Mexicana, el agua de que se dispone para los 
usos dom^sticos, es completamente insuficiente ; me refiero principal- 
mente, d lo que pasa en las fincas nisticas, en las generalmente, ni el 
agua potable es suficiente para el consumo, ni se le cuida evitando que 
sea mancillada, ni viene siempre de manantiales 6 de corrientes puras. 

Justo parece que las grandes ciudades reclamen constantemente, que 
sus aguas se aumenten, que se depuren y se protejan para evitar el que 
sean mancilladas ; en esos centros populosos, en donde la masa de los 
habitantes exige las mejoras en higiene d las autoridades y en donde 
tambi^n existen corporaciones cientfficas y consejos de salubridad que 
velan por la salud de los habitantes, se introducen las mejoras que la 
ciencia exige, se entuban las aguas y se aumenta su caudal ; se esterili- 
zan y filtran por las autoridades en tiempo de epidemia, se dan en fin, 
todas 6 algunas de las garantias necesarias para conservar la salud publi- 
ca. Se tiene ademas otro elemento importantfsimo para sanear las 
aguas, cual es que los habitantes se ilustran por imitaci6n, aprenden d 
conocer, aunque sea de una manera vaga, ios peligros de las aguas impu- 
ras y de esa manera, el individuo se proteje asf como la familia, la colec- 
tividad se expone m^nos, gozando de las beneficios que le proporciona 
el saneamiento de las ciudades. 

No tienen la misma fortuna los campos ; en las fincas nisticas, apesar 
de las buenas condiciones en que los campesinos habitan, por la pureza 
del aire y porque no hay agIomeraci6n, el niimero de casos de infecci6n 
es gp'ande y la mortalidad es exagerada, si se compara con la de los cen- 
tros habitados. 

En pequenas poblaciones adornadas por exuberante vegetaci6n, dota- 
das de un delicioso clima y con poca acumulaci6n, vemos surgir la 
muerte por doqui^r y aquellos lugares floridos y risueiios, en donde 
parece que todo es vida, salud, y alegrfa, la mortalidad esgrande ; y en 
las ^ppcas en que las lluvias faltan 6 son escasas, se desarrollan las epi- 
demias de tifo, sarampi6n, escarlatina, infecciones gastro-intestinales, y 



232 LOS PELIGROS DE LAS AGUAS POTABLES, 

faringitis y amigdalitis infecciosas, de una manera alarmante, mas alar- 
mante aun, rhuchas veces, que en las ciudades populosas. 

Creo yo que esto es debido en su mayor parte^ d que ese elemento 
esenctal para la vida^ el agua^ estd viciada 6 contaminada. 

Si es verdad, que muchas pequeilas poblaciones y fincas de campo, 
tienen aguas de manantiales y fuentes puras y algunas de rios m6nos 
viciados que en la proximidad de las ciudades, otras se surten de pozos, 
de algibes 6 de presas y jahiieyes (reservoirs inperfectos) . En estos 
lugares, las aguas se infectan con g^an facilidad, como es sabido ; ya por 
el acarr^o que las aguas de lluvia hacen de materias orgdnicas altera- 
das y que contienen un numero inmenso de microorganismos infecciosos ; 
de heses, que en las haciendas y pueblos se depositan indistintamente 
sobre el terreno y que son arrastradas d los arroyos, presas y jahiieyes, 6 
se infectan tambi^n por infiltraci6n los pozos que quedan definitivamente 
mancillados. 

£n la Republica mexicana, como en otras naciones, vemos los destro- 
zos que en los caropos tracen las epidemias ; tiltimamente en los ailos de 
'92 y '93, hemos podido asegurarnos, de que la falta de aguas puras, por 
la escac^s de las lluvias, han dado tremendo pdbulo al tifo, que se gene- 
raliz6 en las poblaciones y apereci6 simultaneamente, en todas las pobla- 
ciones de la mesa central de Anahuac. 

£n aquellas que, como Zacatecas y Pachuca, no disponen de aguas 
puras abundantes y en las que por la disposici6n del terreno, es dif/cil el 
aseo sin mucha agua y en las que las aguas potables son impuras la 
epidemia ha sido formidable. 

En las poblacions de veraneo, cercanas d la Capital (Ciudad de 
Mexico) como Tacubaya, Mixcoac, Coyoacan, y otros, que tienen 
aguas discubiertas que no estan canal izadas, 6 que utilizan pozos, mas 6 
m^nos profundos y poco cuidados y generalmente en lugares mal escog^- 
dos ; apesar de las aparentes buenas condiciones de estas fi^rtiles locali- 
dades, el tifo y otras infecciones, han dado un contingente muy notable, 
en la pasada estaci6n primaveral. 

Pocas. poqufsimas personas de las que en esas poblaciones 6 en las 
fincas de campo habitan, saben que se han prcconizado muchos m^todos 
de purificaci(Sn de las aguas, mas 6 m^nos eficaces, como el carb6n, la 
cal, ecf y la filtraci6n, para depurar el agua de los microorganismos pat6- 
genos. La falta de una ilustraci6n conveniente y las ocupaciones y los 
negocios, hacen que no puedan estar las gentes al corriente de los pro- 
gresos de la ciencia y aunque algunos los conozcan, no todos se deciden 
d ponerlos en prdctica. 

Uno de los grandes peligros en los lugares mencionados y en todos 
los semejantes, es, el lavado de las ropas en la proximidad de las dep6- 
sitos de agua de lluvia y de los pozos. A las orillas de estos receptdcu- 
los, se lavan las ropas sin cuidar del escurrimiento de las aguas sucias ; 
se toman las aguas con las mismas cuvas 6 bandejas en que esas ropas se 
dejan reposar, y en esa agua que en muchos casos, va d servir para la 
alimentaci6n y la bebida, sin que se renueve hasta la pr6xima estaci6n de 



LOS PEUGROS DE LAS AGUAS POTABLES. 233 

aguas, es decir durante un aflo, quedan depositadas y en mag^fficas con- 
diciones para prolijerar, todos los g^rmenes pat6geno8, que estan contri- 
buyendo d sostener y propagar las enfermedades. 

Los pozos, que siempre estan situados en los patios y muy pr6ximo8 k 
la habitaci6n y d las fosas fijas que no son impermeables, no estan 
m^nos expuestos d la contaminaci6n por ese medio (el lavado de ropas) 
y por el acarr6o de las lluvias y la in61traci6n del terreno. En efecto, es 
comun ver, que el brocal de un pozo sirve para tender la ropa para la 
desecaci6n, y que esta, aun mojada, estd goteando agua sucia para el 
fondo del pozo y vertiendo en 61 g^rmenes que vienen tal vez de un 
enfermo de tifo, disenteria 6 de difteria 6 tubercul6sis. 

Si el bordo 6 brocal del pozo estd mal construido 6 destruido, hecho 
muy comun, las aguas de lluvia arrastran hacia €\ las majadas de los 
animales, y por liltimo, es comun, que en esas poblaciones, la fosa fija 
est^ pr6xima al pozo, como sucede en Mixcoac, Coyoacan, y en otras 
muchos pueblos y haciendas. No es necesario agregar mas, para pon- 
deraros un peligro tan conocido, pues todos los medicos, que ban for- 
mado parte de una comisi6n de higiene, ban podido sin duda observar 
estos hechos. 

Otro peligro no m^nos grande es originado por la matanza de ani- 
males en la proximidad de los pozos y en las orillas de los rios cuyas 
aguas se utilizan para la bebida. Este hecho he podido observarlo en 
Tula en cuyo rio, no solo se vertia la sangre de los animales sacrificados 
sino que despues se lavaban fragmentos de piel sucios de sangre y del 
lodo infecto de aquel lugar. Observando la marcha de las aguas, pude 
convencerme de que la corriente se dirige d la poblaci6n y en ella se las 
utiliza Uevdndolas por entubaci6n d la fuente de la plaza principal, de 
donde los vecinos se surten para la bebida. En esta poblaci6n, ha 
habido una mortffera epidemia de tifo al principiar el presente afto. 

Creo que es muy importante llamar la atenci6n de las juntas y los 
consejos de higiene sobre este punto, para que se den disposiciones y se 
tomen medidas, contra la peligrosa rutina de los campesinos y de los 
propietarios de fincas rusticas y tambi^n para corregir la incuria de las 
autoridades locales que algunas veces bien lo necesitan en todos paises, 
como lo prueban muchos hechos y de preferencia el siguiente ocurrido 
en una poblaci6n de la Culta Francia : En un pequeiio pueblo de los 
alrededores de Lyon, existia poco tiempo hace, un vasto pantano 6 mas 
bien, un gran lodazal, situado enmedio de la aldea ; el Consejo de 
Higiene del Rh6ne demostr6, para oprobio de las autoridades de aquel 
lugar, que no solo se recogian allf las aguas pluviales; sino las de 
desecho (m^nag^res) de la localidad y las deyecciones de muchos habi- 
tantes y que para colmo de impropieded, estas aguas estancadas Servian 
para abrevar las vacas lecheras y los bueyes del pais y para el lavado de 
las ropas. 

Nada seria bastante para ponderar d cuantos peligros expondria este 
estado de cosas, pues apesar de ello, al tratar las autoridades de cegar 



234 ^^^ PELIGROS DE LAS AGUAS POTABLES. 

aquel en inmundo vaso, los vecinos protestaron bajo el pretexto deque 
siempre lo habian visto y utilizado. 

El mejor medio de corregir los defectos y minorar los peligros que 
vengo senalando, seria sin duda, el dotar d las poblaciones pequeilas y d 
las haciendas de aguas de manantiales 6 de rios, limpias hasta donde es 
posible, mas como por desgracia esto no es practicable en el mayor 
niimero de casos, se debe por lo m^nos procurar, que se cuidan las aguas' 
potables que se tienen y se obligue d los propietarios de fincas rusticas d 
que hagan las obras necesarias para mejorar la calidad de sus aguas 
potables, con lo que sin duda favorecen d los operarios y labradores, que 
les ayudan d hacer considerables fortunas. 

No siempre hay una fuente 6 un rio cercano para llevar por acueducto 
6 entubaci6n las aguas y en este caso se deberia exigir por lo m^nos, el 
que en los pueblos pequeilos y en las fincas de campo, se construyeran 
cistemas de sistetna veneciano^ 6 las modernas impermeables, las cuales 
recogerian aguas de lluvia con aseo y que por su aislamiento y cuidado 
no estarian espuestas d contaminarse fdcilmente. Estas obras nunca cos- 
tarian bastante, si se atiende al beneficio que proporcionarian y d que los 
propietarios hacendados hacen gastos enormes para tener aguas de 
riego 6 aguas motoras, que no siempre son potables y no se preocupan 
de dar aguas puras d sus campesinos y operarios. 

Es pues de todo punto indispensable, que los consejos y juntas de 
higiene, exiten d las autoridades para que tomen en^rgicas y eficaces 
medidas pasa dar bienestar y salud y d las poblaciones campestres y d 
los pobres habitantes de las haciendas. Esto traerd Felices resultados 
para la salubridad piiblica y solo se podrd conseguir, cuando las autori- 
dades locales tengan elementos legales, para veneer la resistencia de las 
vecinos y propectarios rurales. 

La conducci6n de aguas de rios 6 manantiales en donde se aprove- 
chan para los usos dom^sticos, se hace generalmente por canales descu- 
biertos, deberia exigirse que cuando m^nos se entubaran en tubos de 
barro vidriado unidos con mezcla hidrdulica y situados cuando m^nos d 
0,6o centimetros de profundidad. 

Si no se dispone mas que de aguas de lluvia, se deberd exigir la cons- 
trucci6n de cistemas impermeables que reciban las aguas de goteras 
aseadas, prohibiendo que se depositen en su proximidad 6 en sus bocas 
objetos 6 materias que puedan infectar las aguas. 

Preciso es tambi^n que por medio de publicaciones de higiene al 
alcance de los vecinos de los campos, se les haga conocer juntamente 
con otros preceptos de higiene, el uso necesario de los filtros y sobre 
todo de los de porcelana comprimida. 



XLIX. 

THE ORIGIN AND DISSEMINATION OF TYPHOID FEVER.* 

By Prof. W. T. SEDGWICK, 
Boston^ Mass. 

In 1886 the state board of health of Massachusetts was re-organized. 
It was placed under the able leadership of Dr. Henry P. Walcott, who cer- 
tainly needs no introduction to this Association. It contained upon its 
membership-roll one of the most eminent sanitary engineers in the coun- 
try, Hiram F. Mills ; and as a medico-legal expert, Dr. Frank W. Draper, 
and others, well known either in medicine or in public health matters. I 
bid you mark the date — 1886. It was at this time that the magnificent 
work of Koch and Pasteur was beginning to bear fruit. In 1884 we had 
the splendid paper of Gaffky, upon the Eberth bacillus, and soon after our 
attention was called to the Eberth-Gaffky bacillus the board began its 
work. It found itself confronted with the prevention of disease, and 
among other diseases with the prevention of typhoid fever. In connection 
with its sanitary work it established the Lawrence experiment station, for 
studying the purification of sewage and water. In connection with the 
work at that time it was inevitable that work upon typhoid fever would 
very soon follow. In 1890 a large epidemic of typhoid fever broke out 
upon the Merrimack river in the city of Lowell. Not long afterward it 
appeared in Lawrence,* nine miles below, and it was evident that an un- 
usual opportunity had come for an investigation of the etiology of typhoid 
fever, or I should say its epidemiology. This epidemic was freely dis- 
cussed, and it was said to be due to all kinds of things ; it was due to 
the dry season, to unknown causes, to climate, it was due to an infiiction 
of inscrutable Providence — in short, it was due to any number of incom- 
prehensible things, but among other things to which it was charged was the 
water-supply, and I was instructed by the state board of health of Mass- 
achusetts to go to Lowell and make the most thorough and careful inves- 
tigation of that epidemic which could be made. It so happened that 
during the previous autumn I was engaged in studying the well waters 
there, and was acquainted with local conditions where a well was found 
which, in its chemical and bacteriological condition, could have produced 
the whole epidemic upon the old theories of the causation of typhoid fever. 
It was unquestionably charged with matters directly derived from sewage. 
Its connection with cesspools was demonstrated by chemical analysis. Pea- 

1 The author desires to have it stated that this article is printed from the stenographic notes. 



236 THE ORIGIN OF TYPHOID FEVER. 

pie were getting the water right and left, and there was every reason why 
they should have typhoid fever on the old theories of the disease. Curious- 
ly enough the people who drank the bad water were comparatively free from 
typhoid fever. On the other hand, in the better sections of the city, where 
the people were using city water, cases of typhoid fever abounded. What- 
ever the cause was, it must be general and not local ; at the same time, 
it must be endemic and not pandemic. In the city of Lowell we had 
upwards of one thousand cases during the whole epidemic. Cases were 
investigated from house to house, and it was denied that the epidemic 
was typhoid fever. A number of physicians considered it typhoid fever ; 
and on getting blanks of the right kind and tabulating the cases, it 
became clear that it was typhoid fever and nothing else. Very soon 
deaths began to occur, and it was fully demonstrated that we had typhoid 
fever to deal with. As I have before said, the cause, whatever it was, 
must have been general and not local : and it might have been milk, 
although the presumption was it was not milk, because cases were 
scattered all over the city pretty evenly. That is not apt to be the case 
in an epidemic of typhoid fever due to milk. It might have been due to 
secondary infection. I shall try to show that there is reason to believe 
that secondary infection is a much more important factor in typhoid fever 
epidemics than has been commonly supposed. Attention was directed 
to the Merrimack river, because it is always infected, receiving the un- 
purified sewage of Concord and Manchester, N. H., and a large inhabited 
area is drained by the Merrimack river. This impurified water the city of 
Lowell until the present time has been furnishing to its citizens for drink- 
ing water. There was no question about the water-supply being regularly 
polluted. Yet careful studies have shown that the city has not suffered 
so much as in the autumn of 1890 and the winter of 1891. 

On going up the river. Dr. Abbott and I discovered a little settlement, 
three miles from Lowell — Stony Brook. There was an epidemic of typhoid 
fever in this town. On studying this with great care, we found there 
nine cases. Four of these proved to be cases of genuine typhoid fever, 
doubtless due to the polluted and infected river. One of them was a 
workman in a foundry, who was so seriously affected with the disease 
as to enable us afterwards to explain the epidemic. This man had sat 
upon a privy overhanging Stony brook, and had literally spent his time 
there. He had thoroughly polluted the stream which in turn fed the 
water-supply of Lowell. 

To give you an idea of the extent of this epidemic, I have some dia- 
grams, which form part of the state board of health exhibit in the An- 
thropological building at Jackson park, and through the kindness of Dr. 
Brewer, I was permitted to take them out and to bring them here this 
morning. These maps are about to be published in the twenty-fourth 
annual report of the state board of health of Massachusetts, issuing 
from the press, and you will find them there accurately reproduced in 
color as here. I may say that we owe to the state board of health of 



THE ORIGIN OF TYPHOID FEVER, 237 

Massachusetts and to the people of Massachusetts the intelligent support 
which allows proper publication of results like these. Too often it has 
been the custom in this country to publish illustrations which are decided- 
ly inferior to those which appear in other countries. I am proud and 
happy to say, that I believe these are creditable to the country, and will 
compare favorably.with similar illustrations published in any other coun- 
try. 

Upon the diagram or map in the middle, you observe Lowell, showing 
the distribution and location of 550 cases of typhoid fever. We have 
other instructive pictures of the condition of the water-supply in this one 
of our largest cities, in which the privies overhanging the brook, three 
miles above the intake from which the water was taken and delivered to 
the people, are well shown. The one of which I was speaking when I took 
the diagram you now see, is the one shown upon this figure (illustrating). 
In this privy, I say^ this poor fellow sat for two or more days at a time, 
and was the source of the tremendous outbreak in Lowell. We can 
explain the unusual occurrence in Lowell of this disease by that fact. 
Nothing of this kind had happened there before for forty years. There 
was every reason to believe that the discovery of these cases adequately 
explained the epidemic, and in order to demonstrate that more clearly I 
show you this diagram, which will be published in reduced form by the 
state board of health of Massachusetts, in which the course of the epi- 
demic is shown and the mortality by weeks given, and the cases occurring 
at Stony Brook are shown upon the same scale of differences in order that 
their relation to the epidemic may be made clear. It is impossible, in the 
limited time at my disposal, to explain the details of these epidemics, and 
you will find a full account in the report to which I have referred.^ 

Immediately after the outbreak in Lowell, there appeared a worse out- 
break in the city of Lawrence. The people of this city received as a part 
of their water-supply the discharges from the open sewers of the city of 
Lowell, nine miles above. Lowell was a city of 78,000 inhabitants, and 
therefore Lawrence got a much stronger dose than Lowell of the disease. 
The result became clear. The deaths in Lawrence followed those in 
Lowell at a time which might have been expected, and showed greater 
intensity, greater fatality, and a greater number of cases than existed in 
the city of Lowell. The demonstration of the constant connection be- 
tween these two cities year after year, and especially of this epidemic, 
has been made by Mr. Mills, and was published in the report of the 
state board of hedth of Massachusetts for 1890. Some of the diagrams 
are apparently so simple, that I am afraid most of you, if you have 
these reports, have passed them over. If so, I urge you to turn back to 
them. There is nothing more instructive in epidemiology than the con- 
stant relation between the causation of typhoid fever in Lowell, and later 
in Lawrence. It is as clear a demonstration as we can possibly get, and 
such as we have to rely upon in these cases. 

^ See Twenty-fourth Annual Report State Board of Health of Massachusetts for 1892. 



238 THE ORIGIN OF TYPHOID FEVER. 

About a year ago the state board of health of Massachusetts learned 
that there was an epidemic of typhoid fever in Newburyport, and I was 
instructed to go there and make an investigation. About six weeks 
before this time, it came to the knowledge of the state board of health 
that the city of Newburyport, having run short of good water from its 
wells, was ch-awing more or less water surreptitiously from the Merrimack 
river, which it was not supposed to be doing. The board investigated, 
and reported that the Newburyport people, so far as they could learn, 
were doing this, and instructed the water company of Newburyport that 
they were doing it at the risk of the lives of people ; in other words, they 
disapproved of the thing, and as strongly as they could, told the people not 
to do it. About six weeks from that time it turned out that the people 
who had been drawing water, as supposed, from the Merrimack river, had 
a special typhoid epidemic ; in other words, drinking ordinary sewage did 
not hurt them, but drinking infected sewage did hurt them, and they began 
to have typhoid fever. The dates were perfect, and a full account of this 
also will appear in the forthcoming report to which I have referred. It 
should not be overlooked that here was one of the most flagrant cases of 
direct violation of the advice of a well constituted sanitary authority, and 
it may serve as an illustration of the necessity of placing in the hands 
of such well constituted authority the power to carry out its recommend- 
ations and to impose penalties for violation of them. 

Shortly after this epidemic in Lowell and Lawrence, we had a cessation 
of violent epidemics in Massachusetts, but, in the spring of 1892, the city 
of Chicopee complained that it was having more typhoid fever than it 
ought to have. Investigation showed that it was suffering from an infected 
water-supply. It had long been using a polluted water-supply. There 
happened, just then, however, to be an outbreak of typhoid fever in Lud- 
low and other places, and it bore its legitimate fruit. You will find a 
chart of that epidemic at the state exhibit in the Anthropological build- 
ing.^ Scarcely was this investigation over before an epidemic broke out 
in the city of Springfield, Mass., which had been going on for some time. 
When I arrived on the ground the local authorities had been on the 
wrong track, and had been listening to the popular idea that this epi- 
demic was due to polluted wells, regardless of the fact that these were the 
same wells that had been used for years without producing any such epi- 
demic. They listened also to the theory that it might be due to a ceme- 
tery not far off, though how the cemetery could have anything to do with 
an epidemic of typhoid fever, no one could see. In epidemics, we have to 
do not so much with the dead as with the living. If there is anything 
clear, it is that living germs are the things which cause these epidemics ; 
whether it be the germs of Eberth or other germs found by bacteriologists, 
I should hesitate to say. Finally it turned out that all these people were 
supplied with milk by the same milkman. Out of forty-six cases investi- 
gated on the day of my arrival, forty-five had the same milkman. I may 

« See report already referred to. 



THE ORIGIN OF TYPHOID FEVER. 239 

say that having fastened the blame upon the milkman we met with lying 
and deception. We succeeded in getting ahead of the lying and decep- 
tion, and found out where the milk had come from. We did not succeed 
in finding to our own satisfaction how the milk got infected. We did find 
this: Upon a milk farm there had been cases of typhoid fever in the 
milkman's family, and the dejecta, to a large extent not disinfected, had 
been placed in the privy. The privy was emptied upon a tobacco field, 
from which the milkmen went to the top of the well, where there were 
some loose planks. Here they walked about washing the milk cans. The 
cans were submerged beneath the surface of the water ; if infection could 
have got into the water, it might have got into the cans. (In this investiga- 
gation I ought to mention my colleague. Dr. Walter H. Chapin, whose name 
appears in the report along with my own.) On pulling the milk out of the 
water in the tin cans, we found that the cans leaked. If a can would leak 
milk in the air, it was reasonable to suppose it would leak water, conse- 
quently there was a chance for the water in the well to get into the milk- 
cans. The exact means of infection we do not know. From a tobacco field, 
where men are working with boots covered with mud — a thing which we 
saw personally — to a well not far off, is not a difficult journey, but whether 
infection occurred in that way we do not know. It is known that a low 
class of tramps are hired from time to time to do the milking, and people 
when they buy such milk scarcely know what they are drinking. But 
whether the class of tramps employed to do the milking, coming and going 
as they do, have walking typhoid fever or not, the physicians in hospitals 
alone know. We did find this : We proved unquestionably that it was a 
milk epidemic. There were twenty-five people killed by it and one hun- 
dred and fifty wounded. As it was " only " an epidemic of typhoid fever, 
the dead were buried, the wounded recovered, and the people went on 
taking milk from the same milkman. We did not prove, beyond all per- 
adventure, how the infection got into the milk ; we can only suggest vari- 
ous ways.^ 

There is still a third class of epidemics investigated by the state board 
of health of Massachusetts to which I wish to invite special attention, 
namely, those epidemics due to what I may call secondary infection. One 
of these is shown upon a diagram which I show you. You will see the 
location of the milk epidemic to which I have referred, which infected the 
best part of the city of Springfield. Please bear in mind that the typhoid 
fever was not in the filthy part of the city, but in the magnificent portion 
of the town, where the houses have fine lots, where every prospect pleases, 
and where only milk is infected. It is now of secondary infection epi- 
demics of which I wish to speak. 

I have here an example in the town of Palmer. There is a district called 
Duckville, which is a portion of the village of Bondsville. There appeared 
here, after the Springfield milk epidemic, an interesting outbreak of typhoid 
fever cases in the neighborhood of a well, which was located only thirty 

* See report referred to. 



240 THE ORIGIN OF TYPHOID FEVER, 

feet from the worst privies I ever saw. I saw houses grouped around 
the well, and the well was apparently in a terrible condition. On taking 
samples from it and examining them chemically and bacteriologically, we 
found absolutely no typhoid-fever bacilli and hardly any germs of any 
kind. The water was seemingly reniarkably well purified. From a chem- 
ical point of view, also, it was unobjectionable, because the well was a 
driven one, and the privies near by did not contaminate it. We found on 
tabulating the cases and making dates, that there was a curious sequence 
in the cases. They did not come do¥ai, as the cases in Springfield, with 
one blow, as if some poison was widely distributed to many houses at 
once ; nor did they come down as at Lowell. They came down one on 
the first day, two on the second, one on the ninth, one on the twelfth, two 
on the fourteenth, and so on for a month. We found, in fact, a succession 
of cases. Beginning at number one, I traced the thing along until it 
spread to other portions of the village. On trying to find out the cause of 
this, I went into one of the houses of low grade in which the inmates 
were filthy in their habits. On one occasion I had a revelation : I found 
four people sick with typhoid fever in one room, and two in bed in an 
adjoining room. Those in the room were gathered around a table on which 
there was some food. Some in the prodromal stages were still sitting up. 
They were children, and would get off the chair on which they were sit- 
ting, go out to the privy, and then come back, and without washing their 
fingers would stagger up to the table and finger a big piece of cake which 
lay on it. They would then nibble a little bit, leave the rest, and sluggishly 
walk back to their seats. Another child would get off its chair, or a child 
would come in from the outside, would go up to the same table, break 
off a piece of cake, and eat it. There was no question about how the 
infection was spreading in a case like that. From case A something was 
left upon the cake, and from the cake it soon found an entrance into the 
alimentary canal of the next child. The children went from house to 
house — they live pretty much together — the food stands on the table from 
day to day, and they lived that kind of life in which the children eat 
food in common, and the food which went into the mouths of A, B, and 
C, was fingered by D, E, and F, and it only required that D or E should 
have a case of typhoid fever to infect the others, one after another. We 
found, moreover, that the first case was unquestionably imported from a 
neighboring town, having been distributed in the way I have described. 
A large boarding-house, the occupants of which were using the well-water 
all along, did not contain a single case of the disease ; so I was forced to 
the conclusion that the well had nothing to do with it. In fact, I have yet 
to see a case due to polluted well-water. 

The Lawrence experiment station has done an immense service by 
showing how water can be purified by a few feet of common sand. I am 
inclined to think that in some of our books on sanitary science the strik- 
ing diagrams which we see of the house privy, and the drippings running 
from the privy into the well, will have to be modified. In considering the 



THE ORIGIN OF TYPHOID FEVER. 24I 

condition of our wells, I am afraid we have forgotten to look at dirty fingers. 
Another secondary infection epidemic occurred in Provincetown. There 
was a family of ten, nine of whom had typhoid fever. They had it in five 
crops, each two weeks apart. The first one was the caiie of a child, 
who brought it in from one of the other families near by ; then came a 
sister and one brother, at the end of two weeks, that is they got the dis- 
ease from the first child. The second crop soon bore its fruit, and there 
were five successive crops, each two weeks apart, until nine out of ten 
were stricken with typhoid fever. 

I would like to say now, that under these circumstances we have inves- 
tigated thoroughly some six or eight epidemics of typhoid fever. Several 
of these have been due plainly to secondary infection, and I believe that 
old Dr. Budd was right when he said that we got it from washer-women, 
from servants with infected fingers, from polluted water, and from infected 
milk, — ^that we got it from outside, somewhere. If any of you will turn 
back and read Dr. Budd's book on typhoid fever, you will find that we 
have to-day very little which is new. All I can say is that old truth is 
just as good as new truth. Truth never grows old, and each generation 
has to learn for itself. But over and above epidemics from water pollu- 
tion, over and above epidemics from milk infection, we are finding in 
Massachusetts a surprising number of cases, and these are often small 
epidemics rather than big ones, in which we believe secondary infection, 
through the food and fingers, carried by dirty or spotted fingers, is the 
real cause of typhoid fever. 



MUNICIPAL SANITATION. 

By SARAH HACKETT STEVENSON, M. D., 
Chicago, 

I am quite startled at the high sounding announcement of my subject. 
I had hoped to have time to prepare a paper for this body, and if I had I 
should have chosen for my subject "The Disposal of the Dust of the 
City." I remember when a child, reading one of Walter Scott's novels — 
" The Antiquary," I think — in which the sister of the antiquary was very 
anxious about the condition of the library, and the antiquary would say 
that it was the most peaceful dust in the world if it were let alone. 
I think of that daily, when I see the street sweepers going through the 
streets of Chicago. If the dust were let alone it seems to me it would 
be very much better, much less injurious than treated as it now is. 
The question of the disposal, or rather the management, of the dust 
in public buildings, especially in school buildings, is one of the most 
important as regards municipal sanitation. There seems to be an end- 
less amount of work to be done in this direction. If we were to 
begin with the janitors of our public school buildings and teach 
them how to take care of the dust that accumulates in these buildings, 
to make it the least harmful to the hundreds of children that are 
obliged to sit in these rooms throughout the week, we should accom- 
plish a good deal. We find that the ordinary janitor simply stirs up the 
dust and lets it settle again, and when the children are walking about 
the floors, or up and down stairs, this dust is simply raised over and 
over again, and if taken out of the buildings at all, is swept into the 
streets. Now, it occurs to me that the sanitary thing to do would be 
to destroy it, to bum it up, — and the furniture should be wiped off with 
damp cloths, disinfected. 

I really believe that if the health officers of our towns and cities were to 
look into this matter, very many of the epidemics that break out in schools 
might be prevented. We know that many of the contagious diseases are 
carried by the inhalation of dust. We are all familiar, as physicians and 
as public health officers, with the experiments that have been made in 
regard to the contagion of consumption. While it is moist, wet, there 
is very little danger of its transportation, but the expectoration becoming 
dry, and the bacilli having wings, so to speak, given them by the clouds 
of dust in the public buildings, raised particularly in going up and 
down the stairs, the people who are going in and out of these buildings, 
or sitting in them for any length of time, are subjected to that contagion. 



MUNICIPAL SANITATION. 243 

Then we have the various exanthematous diseases which are communicated 
in very much the same way. The experiments which were carried on 
by Professor Tyndall and others, have proved that the dust taken from 
even a very small surface of a wall contains many of the bacilli, it being 
particularly true of the microbe of consumption. Consumption being one 
of the most prevalent of the contagious diseases, it will stand as a type 
for all of the others. I have no hesitation in saying that this matter of 
taking care of the public buildings, the school buildings especially, should 
receive more interest and attention from public health officers. The same 
thing is true of halls and churches. Janitors sweep dirt and dust out on to 
the sidewalks, and the dust is blo¥m back through the windows and doors. 
We know that many of these microbes can be destroyed only by burning ; 
that fire is the great purifier, and there is no reason why this dust cannot 
be safely disposed of if the people were taught the dangers of it ; and, 
especially, if the men who have the public buildings in charge could be 
instructed in this one particular, many lives might be saved, and a great 
deal of sickness would be prevented. 

In regard to the method of disposal of dust, I am very much afraid I 
shall trespass upon the ground of the health officers of this city in saying 
very much on this phase of the subject. I perfectly understand the plan 
which is followed now. I have recognized the same pile of dust on the 
streets for the past twenty years. I really think that the same dirt is mud 
one day and dust the next without really very much change in the particles 
thereof. The whole system of disposing of it, I think, is wrong. The 
sweeping of streets — I can see no reason why they should not first be 
thoroughly sprinkled before they are swept, and then the sweepings picked 
up before they become dry and blown about again. As it is now, the 
same material is piled up on the sides of the streets ; some of it is carted 
off, but a great deal of it is left behind. It dries and blows around in the 
form of dust ; then it rains, and we have mud, and so it goes on. It 
seems to me these sweepings can be utilized, and it is said that in some 
instances fortunes are made out of it. The work is done by private 
enterprise, and the dust and sweepings are used in filling up vacant lots 
and so on. I believe Charles Dickens, in one of his novels, tells us about 
the great fortimes made of accumulations of dust. There is certainly a 
great deal to be said against the system that is now in vogue. If any of 
you have ever had any experience in passing the streets during the march 
of street-sweepers, you know that it is almost impossible to breathe on 
account of the clouds of dust that rise from the sweeper, and in my 
opinion it is better to let the dust remain where it is than to disturb it. In 
our households the same thing holds true. The ordinary housemaid simply 
stirs it up : she does not dispose of it ; there is very little ever disposed 
of. It is sometimes swept into the streets, but as a rule, it is stirred up 
from the floor on to the furniture, then dusted off with a feather duster 
into the air and back on to the floor again. It keeps up its endless 
round of devastation, for that is really what it amounts to. Books, 



244 MUNICIPAL SANITATION, 

pictures, and everything in the house are simply catch places for this 
ever-moving dust. There should be in our households some plan by 
which this could be prevented. The few remarks I had the honor of 
making before this body on the opening day, to the effect that our work 
must be begun with the individual, are true in this particular. We should 
educate domestic servants how to sweep and dust a room. The carpet 
sweeper — ^you must excuse me if I speak of practical points in this con- 
nection — is a great improvement over the old-fashioned broom. It does 
not raise the same amount of dust; but the contents of the carpet 
sweeper should be burned ; instead of that they are usually emptied out 
upon some alley, sidewalk, or street, as the case may be. The furniture 
dust should be taken off with a cloth, and that cloth should be boiled in 
water so as to kill any contagious microbes that may be in the dust, 
instead of having the furniture dusted with a feather duster throwing the 
dust back again into the air and settling down on to the carpets or 
pictures. 

This subject opens up the whole question of house furnishings. In my 
own judgment there should be no carpets on floors. The floors should 
be made of wood, and made in such a way that the cracks should be ren- 
dered impervious, and then rugs that can be taken up and cleaned should 
be placed on the floor Every one who lives in a city or large town is 
annoyed at the return of house cleaning, by the beating of carpets on 
every vacant lot, and Heaven knows what may be in those carpets 1 The 
laws of every city should be such as to prohibit the beating of carpets 
on vacant lots, on streets, or in any such public places. If people will 
have these filthy things on the floor, let these carpets be taken to an insti- 
tution or place where they can be cleaned by machinery, and then the 
dust in the place could be collected and burned. It must be a very 
unhealthful and unpleasant occupation to work in these carpet cleaning 
establishments, still it can be done at these places with greater safety than 
in vacant lots or alleys. I believe very much injury is done in this way, 
the air being contaminated by the beating of carpets. If housekeepers 
and school-children are taught that carpets nailed down on the floors are 
collecting dust of all descriptions and diseases of all kinds, we shall in 
time do away with the fashion. The same thing holds good of hotels. 
Hotels are the hot-beds of all sorts of contagion. Then come the heavy 
draperies at the windows ; they gather a great deal of dust, and it is 
impossible to make them hygienically clean, and so we might go through 
the whole house with its furniture. We have difficulty in cleaning our 
houses thoroughly, because of the impossibility of putting water or a dis- 
infectant upon fine furniture. It is very difficult to rub a highly polished 
piece of furniture with anything moist. These practical questions should 
be looked into and some solution found whereby the dust which accumu- 
lates should not be allowed to go on its everlasting way. 

Speaking of the upholstering and the carpets of houses, the carpets of 
churches, and of hotels, and those heavy, stuffy things that hang on the 



MUNICIPAL SANITATION. 245 

windows, full of everybody's exhalations, brings me to the question of dust 
which accumulates in sleeping-cars. If there is a horrible thing on the 
face of the earth, I think it is the sleeping-car with its heavy upholstery 
and its curtains hung before us all night long, in the filthy, contaminated 
air 1 How is it possible to cleanse those thick plush cushions and the car- 
pets nailed down on the floors ? It does seem to me there is a very wide 
field here for health officers. And then we come to the steamers — the 
furnishings of steamboats and ships. While people may be much benefit- 
ed by an ocean voyage, I think a great many lose their health by it. The 
staterooms in our steamships, no matter how elegantly furnished, admit 
very little fresh air, and it seems to be almost an impossibility to cleanse 
them thoroughly; and then, too, they have all these heavy hangings, heavy 
carpets, heavy draperies, the very things that should be avoided in all 
public conveyances. The very things which should be left out are put 
in, and the more elegant they are, the more dangerous they are. I some- 
times think if we could have a view by means of the microscope, of 
these beautiful hangings and beautiful carpets, we should be appalled 
with the sense of our danger. 

So if I had had the time and ability to write a paper, I should have 
written it along these lines. I certainly think there is a wide field for sani- 
tary men and women, especially the latter, along this line. The women 
should be educated to know these things, and I have faith to believe that 
the men in the family would learn to act upon them. It is really on ac- 
count of our ignorance that we keep our houses in this way, and that our 
churches are furnished in this manner, and that our public halls and 
school-houses are in the condition they are. I feel that the question of 
school-house sanitation is one of the most important we have to consider. 
I was struck some time ago with the statement made by some sanitary 
writer, that we could never get rid of the peculiar odor of the old school- 
house. He cited many cases of old-fashioned country school-houses and 
the peculiar odor in these old buildings. Although they have been left 
to stand for a long time with windows out, a peculiar odor remains, which 
we recognize as school-house odor, that comes from the large number of 
children being closely confined. If these old school-houses were inspected 
by our sanitary chemists, and the dust on the walls analyzed, we might 
find some curious microbes. The place to begin our work is to have women 
placed on the boards of health and school boards. Sanitation is to com- 
mence in the home and in the schools, and from these central points we 
should educate the people until we can get individuals interested in muni- 
cipal sanitation. No state, no nation can do anything. As long as the 
individual is satisfied with his own filth you cannot educate the nation 
out of it, because the nation is made up of the individuals, and the state 
likewise. It is utterly impossible to try to enforce laws when the people 
themselves do not believe in them. 



LI. 

HOW SHALL OUR LEPERS BE CARED FOR? 

By benjamin LEE. A. M., M. D., Ph. D., 
Secretary of the State Board of Health of Pennsylyania. 

" Our lepers ! " When the writer, as well as many of those who listen 
to him, indeed, was a student, such an expression would have seemed 
absolutely meaningless; as much so as the phrase, '^ state medicine," 
with which our ears are now sufficiently familiar. " Lepers 1 " Of course 
we had read about them in the Bible. There were Naaman, the Syrian, 
and the Samaritan whom Christ healed, but all that happened in the dim 
past, centuries on centuries ago. It is true that sometimes a traveller in 
the far East would return with the story that cases of the loathsome 
disease were still to be seen in out-of-the-way places, but little credence 
was given him. And now we talk of ''our lepers," and unfortunately 
have full justification for using the expression. We live in an age in 
which the ends of the earth are come together. So rapidly do we course 
around this little globe of ours that East and West have almost ceased to 
be, a few short days converting the one into the other. The secrets of the 
remotest India have been laid bare, revealing thousands — ^nay, tens of 
thousands— of sufferers from this lingering torture, this living death ; and 
the populations of the two hemispheres are rapidly interchanging and 
commingling. And so it has come to be that the western world now also 
numbers its lepers by thousands, while fifty years ago only the initiated 
knew that near a great city in the extreme southeast comer of the United 
States, lepers were lurking in an obscure, out-of-the-way village. 

The State Board of Health of Pennsylvania and the Board of Health of 
the city of Philadelphia have had some unpleasant experiences with lepers, 
which have led both of those bodies to appeal to the general government 
to establish a colony or colonies where these unfortunates might be pro- 
vided with the comforts of home and medical care and nursing ; and, at 
the same time, might cease to be a horrid menace to the health of those 
with whom they were thrown in close contact. In order to arrive at a 
somewhat definite opinion as to, first, the need for the adoption of such a 
measure, and, secondly, the general drift of opinion on the part of those 
who had given the subject thoughtful attention, in December, 1891, 1 
addressed circular letters of inquiry to the secretaries of all state and 
provincial boards of health in the United States and Canada, and to 
prominent dermatologists. The letter to state officials was as follows : 



J/0 IV SHALL OUR LEPERS BE CARED FOR? 247 

Commonwealth of Pennsylvania, 
State Board of Health, Executive Office, 1532 Pine Street, 

Philadelphia, Dec. 30, 1891. 



To the Chairman of the State Board of Health of the State of ; 

Dear Sir : Being desirous of obtaining reliable information as to the prevalence of 
leprosy in this country, I request of you the very great favor of a reply to the following 
questions : 

First. How many cases of leprosy have been observed in your state ? 

Second. How many cases at present exist in your state ? 

Third. Is any provision made for the segregation of lepers in your state ? 

Fourth. Is any provision made for the shelter, support, and medical care of lepers in 
your state, either by state or municipal authorities, by private societies, or by individuals ? 

Fifth. Has your board adopted any minute, resolution, or regulation with regard to 
lepers found within the borders of your state, such, for instance, as requiring the disease 
to be reported to boards of health, as is done in the case of other communicable diseases ? 

Sixth. Have you any knowledge of lepers having passed through your state ; and, if 
so, in what sort of conveyances ? 

Seventh. Are there reasonable grounds for supposing that there are lepers concealed 
in any of your larger towns ? 

Eighth. What is the Chinese population of your state and of your several large towns ? 

Ninth. Do you know of any cases of leprosy having originated in your state ? 

Two principal objects were had in view in this series of inquiries : First, 
to get at the geographical distribution of the disease in this country ; and 
secondly, to discover to what extent its presence had been recognized and 
made the subject of official restriction or legislative enactment. 

As regards the first point, viz., the geographical distribution of the 
disease, the attempt was made to obtain advance sheets of the United 
States Census Report for 1890, containing this information. The reply of 
Surg. John T. Billings, in charge of that department, is as follows. I ask 
especial attention to the last sentence, as it indicates very clearly the 
difficulty of obtaining definite and truthful replies to questions on this 
topic. Not only householders, but physicians as well, will be loath to 
disclose this dread secret : 



War Department, Surgeon-General's Office, 

U. S. Army Medical Museum and Library, 

Corner Seventh and B Streets, S. W., 

Washington, D. C, Jan. 12, 1892. 
Dr. Benjamin Lee, 

Secretary of the State Board of Health of Pennsylvania^ Philadelphia^ Pa. : 

Dear Sir*: Yours of the nth instant is received. The information with regard to 
leprosy, contained in the census statistics, is not yet compiled, the work on the vital 
statistics having been suspended for several months, owing to want of clerical force. As 
soon as the deficiency appropriation which has been asked for has been granted I hope 
to have a number of clerks put on this work, and in the course of three or four months 
to be able to give you the information you desire, so far as the records of the census 
contain it. I fear, however, that they will be very incomplete as regards the existence of 
leprosy, since householders would not report cases if they could avoid it. 
Very sincerely yours, 

J. S. Billings, 

Surgeon^ U. S, Army, 



248 HOW SHALL OUR LEPERS BE CARED FORt 

In the same line of thought Dr. H. S. Orme, president of the State 
Board of Health of California, in his admirable essay, " Leprosy ; its 
Extent and Control, Origin, and Geographical Distribution," says : 

I have no doubt that the practice of secreting lepers is general throughout the world, 
wherever the disease prevails, and it is not difficult, in an early stage, for lepers to evade 
the authorities and go about their usual business. 

It does not at all follow, therefore, that because state officials are not 
aware of the existence of cases of leprosy within their borders, such cases 
do not exist. 

Replies to these inquiries have been received in twenty-three instances. 
They indicate, briefly, that cases of the disease have been recognized and 
made the subject of official report in seventeen states and provinces, viz. : 
New Brunswick (including Cape Breton), British Columbia, Massachusetts, 
New York, New Jersey, Pennsylvania, Maryland, South Carolina, Florida, 
Illinois, Iowa, Minnesota, Wisconsin, Nebraska, Louisiana, California, and 
Oregon. 

The authorities of twelve states and provinces have no knowledge of 
any case ever having been seen within their borders. These are Ontario, 
Quebec, Vermont, Connecticut, Delaware, North Carolina, Alabama, Ohio, 
Michigan, Indiana, and Kansas. 

In ten states or provinces cases exist at the present time, under the 
observation of the authorities, namely : New Brunswick, twenty-two cases ; 
British Columbia, seven cases ; New York, six cases \ Pennsylvania, four 
cases; Illinois, two cases; Iowa, one case; Minnesota, seven cases; 
Wisconsin, four cases ; Louisiana, forty-five cases ; California, twenty-four 
cases, making, in all, one hundred and seventeen cases. 

Comparing my own returns with the carefully prepared statistics of 
others, I am led to conclude that since the middle of the present century 
about six hundred and twenty-five lepers have been domiciled in North 
America, not including Mexico. The greatest number in any one state or 
province has been in California, owing to Chinese immigration, where not 
less than two hundred have been registered, and the next greatest in New 
Brunswick, where the names of one hundred and thirty-two are on record. 

Original cases, by which I mean those in which the patients either 
resided on this continent and contracted the disease by contagion in this 
country, or those in which the patient had contracted the disease in other 
countries, but in whom it had given no sign of its presence before they 
came to this country, have been observed in seven states and provinces, 
viz. : New Brunswick, Pennsylvania, Maryland, South Carolina, Minne- 
sota, Louisiana, and California. There is good reason for believing that 
cases of this description have occurred in Wisconsin and Iowa, also, 
Now, leaving the question of the geographical distribution of the disease, 
let us see to what extent state governments and sanitary authorities have 
considered that its presence imposed any responsibility upon them to 
prevent its spread. We find only two legislative bodies which have 



HOW SHALL OUR LEPERS BE CARED FOR? 249 

enacted laws upon the subject, those of the Dominion of Canada and 
of California, in both of which jurisdictions the reporting of leprosy is 
made compulsory by special enactment. It is claimed, however, by the 
boards of health of several of the states, that the general provisions with 
regard to contagious diseases enable them to deal with leprosy as a con- 
tagious disease if they see fit. In three states the state board of health 
has adopted a special regulation requiring the reporting of the disease. 
They are Maine, Pennsylvania, and California. 

Segregation or isolation is required, either by legislative enactment or 
by the sanitary authority, in New Brunswick, British Columbia, Pennsyl- 
vania, New York, and Wisconsin. 

Provision is made for the maintenance and medical care of lepers in 
New Brunswick, British Columbia, and Wisconsin by the state ; in Penn- 
sylvania and California by the county authorities. In Minnesota they are 
registered and kept under observation, but are not prevented from ming- 
ling with the public. 

The only boards which possess knowledge that persons affected with 
this disease may have passed through their territory, are those of Ontario 
and California. It is evident from the records of hospitals and the 
admissions of private practitioners, however, that there is not a state in 
the Union through which they have not travelled. 

The facts which we have arrived at, then, are, first, that so far as the 
national governments are concerned, those of Canada and the United 
States have both put themselves on record as holding leprosy to be a con- 
tagious disease of such nature and character as to make it a menace to the 
public health, and to entitle it to ofHcial recognition and oversight. The 
former has passed laws compelling the segregation of every case discov- 
ered, and at the well-known Lazaret at Tracadie, in the province of New 
Brunswick, provision is made for the comfort, care, and treatment of these 
unhappy beings in a manner in harmony with the dictates of humanity 
and the requirements of modem science, while at the same time they cease 
to jeopardize the health and happiness of others. The United States has 
only gone so far as to make the affection quarantinable at the sea-coast, 
and to order those found suffering from it on arriving vessels to be at 
once returned to the ports from which they came. In the different states 
of the Union the widest diversity prevails, both in theory and practice. 
The only place in which segregation is practised, and at the same time 
humane provision is made for the shelter, maintenance, medical attend- 
ance, and nursing care of lepers, is the city of Philadelphia. The manner 
in which the county authorities, who have the care of the other cases in 
Pennsylvania, discharge this duty, is by no means in keeping with the dic- 
tates of humanity or the laws of sanitation. The sole occupant of the pest- 
house which has been assigned to him, his food is passed in to him as it 
might be to a wild animal. He has no attendant, and is obliged to do 
everything for himself. Occasionally his loneliness becomes unbearable* 
and he makes excursions into the surrounding country, and even into 



250 HOW SHALL OUR LEPERS BE CARED FOR? 

neighboring cities. What will be his condition when he becomes unable 
to help himself, is unpleasant to contemplate. In making this statement 
I am not desiring to reflect upon either the humanity or the intelligence 
of the poor directors or county commissioners. They are possibly 
doing as well as they can under the circumstances. The condition 
is owing to the failure of the national government to provide a refuge 
for this wretched being, and for the hundred others like him who are drag- 
ging out miserable existences in different parts of the country. While 
their numbers are few, no little rural community — very few states, even — 
feel justified in going to the expense of establishing a lazar house or 
colony. Is it wise to wait until state after state finds itself compelled by 
their increasing numbers to take this step, or is it not, rather, the duty of 
the central government to gather them all into one properly supervised 
conununity, where they can have the companionship of their fellows, the 
comforts of a thoroughly furnished home, and the advantages of the best 
medical and surgical skill ? 

Such is the distinctly expressed opinion of nineteen of the twenty-one 
eminent dermatologists who favored me with replies to my circular of 
inquiry. I may, perhaps, be allowed to quote briefly from some of them. 

Dr. James C. White, of Harvard university, says : 

The disease is bound to increase with all these foci in our midst if the national govern- 
ment does not take immediate steps for its segregation while it yet remains in manageable 
numbers. I favor the foundation of a national asylum, with perpetual isolation, and the 
establishment of local hospitals or special wards for observation and determination of 
diagnosis. 

Dr. H. G. Piffard, of New York, remarks of the establishment of a 
national leper colony : 

This will have to be done, sooner or later, and the sooner the less difficult the under- 
taking. 

Dr. Charles W. Allen, of New York, considers that 

Public welfare demands that some law be enacted by the national government which 
will prevent lepers from entering this country from any side, and compel those now here 
to enter a suitable hospital. State legislation will not furnish the necessary relief, for if 
we prevent lepers from remaining at large in one state, they will only be driven to some 
other part of the country. 

It is a question of national interest, and must be settled on the basis of what means 
will prevent a national calamity. Segregation has been proved to be the only sure means 
of freeing a country from the ravages of this disease. It is the duty of the government, 
through national legislation, to establish one or more central leper hospitals or isolated 
settlements for the segregation, care, and scientific treatment of those afflicted, and for 
the protection of the community at large. I do not desire my reply to be confidential. 
In fact, I deem the question of such importance that any facts relating to it, if they can 
help to bring about the suitable means of freeing the country from so dire a disease, 
should have the widest publicity. 

Dr. John T. Bowen, of Boston, says : 



HOW SHALL OUR LEPERS BE CARED FOR? 2$X 

Isolation of the infected, with all precautions as to antisepsis and cleanliness, are 
imperative. 

Dr. Samuel Sherwell, of Brookl)m, while not convinced of the necessity 
for segregation in this climate, holds that, if so considered 

It would, undoubtedly, be best attended to by the central government and the selection 
of an isolated spot, where temperature and hygiene were both favorablCi in this way 
securing one focus only, instead of numerous fod, for the spread of possible contagion. 

Dr. George Thomas Jackson, of New York, thinks that 

The best means of preventing the spread of the disease would be by the establishment 
of leper colonies by the national government in different sections of the country in which 
the disease is most commonly met with. 

Dr. R. H. Daly, of Pittsburgh, says : 

The time has come when the national or state legislators ought to take some adequate 
action to prevent the ingress of lepers into the United States, and also to forcibly isolate 
those already within our borders. It is, therefore, the duty of the profession to instruct 
the legislators and the public upon this question. It is a matter of congratulation to 
Pennsylvanians that their State Board of Health had recently sent to the profession 
circulars making inquiries, for the purpose of urging legislation. But the profession can 
do little or nothing without the aid of the public, who are indebted to the unselfish recom- 
mendations of the medical profession for light in matters of public health. Hence the 
public ought to be informed as to the needs of the hour, and urged to act through their 
representatives. 

In conclusion, I desire to say, that in determining the importance of 
this question and the necessity for governmental interference, the numeri- 
cal method is entirely misleading. One case of leprosy outweighs a 
hundred of any other disease. If there were but ten lepers in the land, 
instead of more than ten times ten, it would be equally the duty of con- 
gress to initiate measures to prevent, if possible, a single addition to the 
horribly afflicted company. Listen to Dr. Daly's description of an unfor- 
tunate one of our own countrymen, whom he observed in Havana. This 
was a native of the United States, named Joseph Miller, one of the sur- 
vivors of the massacre of the crew of the filibustering ship Virginius^ in 
the year 1872. 

At the time of his rescue he was a hale and hearty dark mulatto, but 
thirteen years of leprosy had turned him white ; it had also made him 
handless, footless, sightless, noseless ; it had left him without ears ; it had 
left him without what would be recognized as a human voice ; it had left 
him a hideous, ghastly creature, without hope in life — a mere thing, whom 
to look at is to make the stoutest heart shudder, whom to touch is to take 
the greatest possible risk of contagion that is sure to destroy. And such 
destruction ! No other cruel thing known is so cruel. A weary journey 
of years with weary limbs, over which there is no power ; shunned as no 
other being is shunned ; cast out as unclean, to await the day when the 
horrible, hideous mass of decay will cease to live. 



252 HOW SHALL OUR LEPERS BE CARED FOR f 

LEPROSY. — A LETTER FROM DR. HANSEN. 

Bergen, Sept 24, 1893. 

Dear Dr. Hewitt : I shoald like it very much if I were able to go to Chicago, tmt I 
have not money enough for it, so I will send you some words on the leprosy question 
which you can perhaps make use of. 

As to the contagiousness of leprosy, there can, in my opinion, be no doubt, when we see 
the results of isolation in Norway. But it demands, evidently, very peculiar circumstances 
in the intercourse of man to transmit the disease ; probably there must be an erosion of 
the skin, a want of epidermis, through which the bacillus can enter by a sort of inocula- 
tion. To prevent the contagion, it will therefore suffice to shun a too close contact with 
a leper. We are also so ignorant about this matter that it is impossible to say anything 
with certainty. We can only judge from more or less uncertain experiences. Now, the 
di£Eerence between the habits of my countrymen, at home and in America, I found to be 
the degree of cleanliness. At home they are not at all cleanly; in America they kept 
themselves and their houses clean, as far as I saw. Leprosy did not spread by contagion 
in Minnesota and Wisconsin after my observations, so I concluded that cleanliness is 
sufficient isolation in inost cases to prevent the spread of leprosy. It is quite foolish to 
set the contagiousness of leprosy in a class with the contagiousness of measles or scar- 
latina ; it is more probably to be compared with the contagiousness of syphilis, only one 
must take care not to believe that sexual intercourse is necessary ; it seems, rather, not to 
be very dangerous, as it so seldom happens that married people contaminate each other. 
This has often been brought forward as an argument against contagiousness, but I have 
made some observations of apparently proving weight on contagion between married 
people, and so I say it must be for the coming researcher to find out how it can be that 
it so seldom happens. 

Here in Norway I always say to the lepers, who will live at home, that they must have 
their own bed and their own eating apparatus, which ought to be washed separately, as 
also their linen. When this is strictly kept, I think it quite sufficient ; and I always 
preach for the surroundings — how dangerous, how dangerous it shall be if they allow the 
patient to sin against my prescriptions, and the people will generally have fear of catching 
leprosy. 

. This is a short extract of my opinions, which you may proffer the congress, if you 
should find it suitable. 

I remain, sir, yours truly, 

(Signed) G. A. Hansen. 

To Dr. Chas. N. Hewitt, 

Secretary State Board of Health, Red Wing, Minn, 



LII. 

EL TIFO DE ENERO DE 1889 A JUNIO DE 1893 EN EL 
HOSPITAL JUAREZ. 

PoR EL Dr. LUIS E. RUIZ, 

CaTEDRAtICO DE HiGIENE EN LA ESCUELA DE MEDICINA DE MtXlCO, DIRECTOR 

DEL Hospital Juarez. 
Mixico^ Mix, 

La higiene para alcanzar el trascendental objeto que se propone, esto 
68, para conservar la salud, agrandar la vida media y aumentar el bienes- 
tar social, tiene coixio uno de los mas importantes factores averiguar las 
causas que producen, sostienen, 6 propagan las enfermedades, que como 
desoladores azotes diezman la vida humana y merman la ventura colec- 
tiva. Este conocimiento hace posible la intervenci6n efectiva del hom- 
bre, linica manera de acarrear bienes reales para la human idad. Y 
desde el punto de vista de la ciencia sanitaria el grupo nosol6gico que 
exige, mas que otro alguno, nuestro poderoso Qoncurso para ser extin- 
guido, estA formado por las enfermadades endemo-epidimicas^ puesto 
que la naturaleza de ellas hace presumir que entre las miiltiples circuns- 
tancias del medio en que vivimos existen las causas permanentes de las 
enddades morbosas de que se trata, y ademds dicho medio es susceptible 
de recibir nuevos agentes que, por sf solos 6 unidos k los preexistentes, 
sean capaces de generalizar, en un momento dado, la enfermedad endi- 
mica constituyendo terrible epidemia^ mas 6 m^nos destructora. 

Las endemias principales de la ciudad de Mexico son, d no dudarlo, 
las enfermedades intestinales, la neumonfa, el paludismo, y el tifo; pero 
entre ellas, el nefasto tifo es, si no la mas mortffera, si la mas desoladora, 
tanto porque en la estaci6n de invierno se hace francamente epid^mica, 
cuanto por el temor que infunde su trasmisibilidad (que aunque menor 
de lo que se cree, es sin embargo real) y por la gravedad que reviste, de 
preferencia en las personas que han pasado de los 60 afLos. 

El fin principal de la presente memoria, no es ni siquiera hacer sen- 
cillo bosquejo de la enfermedad de que tratamos, sino simplemente hacer 
algunos apuntamientos, que k manera de cuadro sin6ptico, hagan resal- 
tar algunos de los rasgos que le son peculiares, por el ndmero de los 
atacados, su letalidad y la fisonom/a fundamental que individualiza el 
padecimiento. 

Hecho cargo de las salas de tifo del hospital Juarez, en la ciudad de 
Mexico, en Enero de 1889, desde esa ^poca me ha sido dable observar 
detenidamente, el ndmero de enfermos que all/ han entrado, las varia- 
ciones de cantidad en los ingresos, la forma que en cado caso ha reves 



254 



EL TIFO EN EL HOSPITAL JUAREZ, 



tido, su evoIuci6n general, su gravedad relativa, sus complicaciones y los 
miiltiples inexperados incidentes que vienen d cortar el hilo de la vida 
en muchfsimos casos. 

Durante cuatro y medio afios, esto es, en 1889, 1890, 1891, 1892, y el 
primer semestre de 1893 ingresaron al hospital Juarez 8,823 enfermos de 
tifo, siendo de estos 5,568 hombres y 3,255 mujeres ; de los cuales sana- 
ron 6,526 y murieron 2,297; ^^ ^^^ primeros fueron 4,126 hombres, y 
2,400 mujeres y de los segundos 1^478 del sexo masculine, 817 del feme- 
nino. Esto en la totalidad arroja una mortalidad de 26 por ciento aproxi- 
madamente, que en realidad para los asistidos en el hospital estd l^jos 
de ser cierta, como d su tiempo lo demostrar^. 

HOSPITAL JUAREZ. 

MOVIMIENTO DE TIFO HABIDO EN LOS Af^OS DE 1889, '90, '9I, '92 Y I^ SEMESTRE 

DE 1893. 



Entradas. 



H. 



M. Total. H. 



Salidas. 



M. 



Total, 



Defuaciones. 



H. 



M. 



TofaL 



Afio de 1889 

" 1890 

" 1891 

" 1892 

lo semestre de 1893. 

Sumas 



816 

i»0S3 
1.296 



6SS 
444 
S" 
638 
1,007 



3.25s 



1,471 
1.257 

1,564 
1.934 
2.597 



8,823 



616 

569 

812 

924 

1,184 



4,105 



507 
338 
406 

425 
745 



1,123 

907 
1,218 

1,349 
1,929 



200 

228 

285 

324 
441 



148 
105 
124 
182 
260 



348 
333 
409 
506 
701 



2,421 



6^526 



1,478 



819 



2,297 



En la mayorfa de los afLos, aquf considerados, el niimero de tifoideos 
ha ido aumentando, puesto que en el de 1889 se recibieron 1,471 enfer- 
mos de tifo, en el de 1890 fueron alojados 1,257, en el de 1891 recibieron 
asistencia 1,564, en el de 1892 ascendi6 el niimero d I19341 habiendo 
alcanzado solo el primer semestre de 1893 la enorme cifra de 2,597. 
Esto es, que en el semestre de Enero d Junio del aflo actual el numero 
de tifoideos es casi igual d la suma de los observados en los aflos de 1889 
y 1890, es decir, d lo que ent6nces produjeron cuatro (4) semestres 
juntos. Y como el tifo en el presente mes de Julio, aiin cuando ha dis- 
minuido, estd l^jos de haber llegado a la cifra baja, que comiinmente se 
ha observado en los pasados afLos durante las Uuvias, claro es que se 
puede decir, con toda exactitud, que el ailo de 1893 serd excepcional en 
este sentido. 

La mortalidad en el aiio de 1889 fu6 de 23 por ciento, y en 1890, 1891, 
1892, y primer semestre de 1893 fu6 de 26 y una pequeila fracci6n por 
ciento ; mas dicha fracci6n fu6 aumentando de 1890 d 1893, y por eso se 
considera, como mortalidad media, la de 26 por ciento. 



EL TIFO EN EL HOSPITAL JUAREZ. 255 

Mas para apreciar convenientemente el resultado de la mortalidad. 
para valorar la letalidad real de esta endemo'efidemia en frente de los 
medios que como higienistas debemos oponer d su destructor influjo, es 
de todo punto importante distribuir en tres grandes grupos, todos los 
enfermos de tifo que ban sido recibidos en el hospital Juarez de Enero 
de 1889 i, Junio de 1893. 

Y por defectuosa que aparezca, desde el punto de vista te6rico, la 
clasificaci6n que de dichos enfermos voy d hacer, ella es eminentemente 
litil, y pudiera yo decir necesaria para el medico prdctico puesto que es 
un guia, ya para el terapeutista, en vista de curar d los enfermos, ya para 
el bigienista en vista de prevenir las enfermedades. 

El primer grupo de mi clasificaci6n estd constituido por los enfermos 
cuya edad es de i d 15 ailos. Y sin exageraci6n dir^ que cualquiera que 
sea la forma que en ellos revista el tifo, hay tantos salvados como atacados 
y por lo tanto, la mortalidad se reduce d o. Mas es preciso advertir, que 
el nijmero de atacados, de la edad entre los Hmites seilalados, aunque ha 
sido variable de uno d otro ailo, siempre ha excedido del quinto de los 
enfermos. 

El segundo grupo estd formado de adultos y ancianos (en mayor 
ntjmero los primeros que los segundos) que ingresan al hospital durante 
6 al principio del primer septenario y adultos en el segundo septenario. 
La mortalidad en ese grupo jamds alcanza d cifra decenal, y siempre las 
unidades, si bien altas, representan el tanto por ciento. 

El tercer grupo lo constituyen los ancianos y adultos que ingresan al 
hospital al finalizar el tercer septenario y los muy ancianos concluyendo 
el segundo (equilibrdndose, por decirlo asf, las respectivas cifras de 
estas dos fracciones). La mortalidad, en este caso, es espantosa, 
pudiera decirse que llega d ciento for ciento; y la regla casi invariable 
es que estos desgraciados sucumben dentro de las cinco (5) horas de su 
entrada al establecimiento. Ya se ve, por lo tanto, que hay un contin- 
gente que acrecienta la mortalidad, que aunque es desoladoramente efec- 
tiva para la colectividad, no es m6nos cierto que no lo es en el mismo 
g^ado para el hospital que imparte el tratamiento medico, pues al fin 
de cada mes, y afio por afio se ve que la cifra de mortalidad excede 
mucho en proporci6n al numero de los asistidos realmente. 

Despu^s de esta elemental consideraci6n, fdcil es percibir, comparando 
los grupos 2® y 3^, que su principal diferencia consiste en que los enfer- 
mos del 2^ grupo son alimentados convenientemente, medicinados, y asis- 
tidos, en tanto que los del tercero carecen de estos recursos ; y siendo la 
mortalidad en estos de un modo invariable desmesuradamente grande 
y mucho mayor que en el 2^, nos obliga la Idgica d atribuir d la falta 
de aquellos medios la espantosa letalidad observada en los de dicho 
3* grupo. 

Pues bien, si la experiencia constante y por tantos afios observada 
nos advierte que la entrada fronta al hospital es poderoso factor para 
disminuir la mortalidad, corresponde al poder publico, por medio de la 
autoridad sanitaria, que lo es el ^^Consejo Superior de Salubridad" 



256 EL TIFO EN EL HOSPITAL JUAREZ, 

dictar los medios adecuados para que sea oportuno el ingreso de I08 
enfermos de tifo al hospital. 

£1 C6digo Sanitario, publicado el 15 de Julio de 1891, que es la ley 
suprema en esta materia, en el capftulo IX que trata de las enferme- 
dades infecciosas y contagiosas, previene, en el articulo 243, que los 
medicos den parte inmediatamente al Consejo Superior de Salubridad 
de cualquier caso que observen de tifo. El artfculo 244 hace extensiva 
la misma prevenci6n d los directores de colegios, d los de las fdbricas 6 
industrias, d los duefios 6 encargados de hoteles, mesones, 6 cualquier 
otro establecimiento donde haya aglomeracidn de individuos. El artfculo 
245 impone la misma obligaci6n d los jefes de familia, si el enfermo no 
fuere asistido por medico. Por estos art/culos se ve, que el Consejo 
estd 6 puede estar al tanto inmediatamente de los diversos casos de tifo 
que ocurran en distintos puntos de la ciudad, y que en cada uno de ellos 
deberd resolver lo que juzque conveniente, pudiendo esto ser, para los 
desheredados de la fortuna, su remisidn inmediata al hospital. El arti- 
culo 247 prescribe el aislamiento para los enfermos de tifo, durante su 
tratamiento y convalecencia. El 248 aconseja, siempre que sea posible, 
que el aislamiento se haga en la misma casa del enfermo ; y por dltiroo 
el artfculo 249, para la no posibilidad del artfculo anterior, ordena que 
el enfermo sea llevado al hospital. Y como precisamente los casos del 
30 grupo, d que me reiiero en este trabajo, estdn comprendidos en el 
artfculo 249 ya citado, lo linico que pido es que la traslaci6n se haga 
con entera ofortunidad^ bien seguro que de esta manera se arrancardn 
muchas vidas d la luctuosa muerte. 

Pero con la prdctica de los preceptos seilalados y con el consejo que d 
mi vez formulo, queda garantizado, de cierto modo, un g^an niimero de 
los que se enferman ; mas la higiene solo queda satisfecha cuando ha 
puesto en ejercicio reglas capaces de oponerse eficazmente al desarrollo 
6 propagaci6n de las enfermedades y tal es el segundo aspecto de la 
cuesti6n cuyo estudio presento hoy. 

Siendo el tifo una enfermedad trasmisible y que acaso se generaliza, 
ya por infecci6n, ya por contagio, tenemos el imprescindible deber de 
formular preceptos, que Uevados d la prdctica, scan suficientes para 
oponerse eficazmente d uno y otro modo de propagaci6n. Para lo pri- 
mero bastard respirar buen aire, tomar agua bacteriol6gicamente pura 
y alimentos irreprochables, desde el punto de vista termol6gico. Para 
lo segundo, es de todo punto indispensable la desinfecci6n. En efecto, 
no basta Uevar el enfermo al hospital, lo cual es obrar en^rgicamente en 
pro de su vida, sino tambi^n hacer indemne el medio en que estuvo y 
evitar la posible contaminaci6n de esta manera. 

El articulo 252 ordena la desinfeccidn del local que el enfermo de tifo 
ocupaba, asf como los objetos que pudieron ser contaminados. El artf- 
culo 253 prescribe el aseo de los caAos, albafiales, etc., de la casa habi- 
tada por el enfermo. El 254 prohibe las honras fiinebres de cuerpo 
presente, para los que hayan sucumbido de tifo. Y por Ultimo, el 255 
no permite que esta clase de enfermos sea conducida en coches de servi- 



EL TIFO EN EL HOSPITAL JUAREZ. 257 

cio piiblico. Por todo lo dicho se ve, que el C<5digo Sanitario prescribe 
una serie de medios que tienden ya k curar los enfermos, ya k evitar 
la propagaci6n de la enfermedad. Si k esto se agrega, poni^ndolo en 
pr^ctica, el consejo que doy del ingreso pronto al hospital, es claro que 
haremos un servicio real d cierto numero de pacientes, en la ciudad de 
Mexico. 

Y si estas medidas, sencillas y eficaces, que la obserracidn diaria, la 
experiencia, y el raciocinio abonan como excelentes para Mexico, son 
llevados adaptdndolos d las ciudades del continente de Col6n que est^n 
en semejantes condiciones, 16gico es esperar que los resultados para ellas 
serdn tan ben^ficos como para la capital de la Repiiblica Mexicana. 



LIIl. 

ALGUNAS REFLEXIONES ACERCA DE LA INFECCI6N 
Y EL CONTAGIO DEL TIFO EXANTEMItICO. 

POR EL Dr. RAM(3n ICAZA, 
Mixico^ Mix. 

Senor Prbsidbntb y Senorbs : El tifo exantemdtico es por desgra- 
cia end^mico en la capital de la Republica de Mexico, y d veces, como 
ha sucedido en este afio, toma los caract^res de una verdadera epi- 
demia. 

Teniendo como tenemos tan hermoso clima, es last! ma que tengamos 
tambi^n en nuestro suelo tantas causas de insalubridad. 

Ojald y pronto podamos sanearla/y asf como ya no vemos en los 
hospitales la podredumbre, ni adn las infecciones que dntes complica- 
ban frecuentemente d las heridas, asf es de creerse que llegard un dia 
en el que desaparezca aquella terrible enfermedad. 

Es cierto que todavfa no se descubre el microbio 6 agente misterioso 
que la produce; pero sf conocemos muchas de las circunstancias que 
influyen en su desarrollo, y si bien el higienista recibe con aplauso y 
utiliza los descubrimientos de la bacteriologfa, no por esto debe perma- 
necer inactivo cuando se desconoce el orfgen primero de las enferme- 
dades. 

For mi parte yo creo, sefiores, que estd plenamente demostrado que 
las materias animales en descomposici6n son la causa del tifo. 

En los libros de medicina, se leen muchos casos de epidemias desa- 
rroUadas en establecimientos pdblicos y en navios y casas particulares, 
en los que se ha podido comprobar con exactitud ese hecho. 

Respecto de Mexico, y para no citar mas que algunos, me referir6 d 
la que hubo en el Hospicio de Fobres de esa ciudad el ailo de 1882, y 
d la que se desarroll6 en la cdrcel de la misma capital, el ailo dltimo de 
1892 ; en las dos se descubrid claramente, como causa, la presencia de 
materias estercolares retenidas y descompuestas. 

Alld por el aflo de 1874, vf muchos tifosos en una casa de vecindad 
que era parte del extinguido convento de Jesiis Marfa, y cuyos cailos 
eran focos de putrefacci6n verdaderamente inmundos. 

En muchos de mis enfermos, he sabido con evidencia que han con- 
traido el tifo, por haber estado en algun lugar en donde habia malos 
olores por descomposici6n de materias animales. 

La causa de la infecci6n me parece pues bien definida. 



EL TIFO EXANTEMATICO. 259 

Pero una vez desarrollada la enfermedad en un individuo ^ es 6 no 
contagiosa ? 

Para mi no hay duda que lo es, y como prueba innegable me bastard 
hacer constar el hecho de que los medicos y estudiantes de medicina se 
enferman de tifo en un niimero incomparablemente mayor que los abo- 
gados 6 los ingenieros, por ejemplo. 

Viendo ahora la cuesti6n del contagio mas detenidamente, se nota 
que los medicos, practicantes y enfermeros de las salas de tifo en los 
hospitales son los mas frecuentemente atacados. 

Haciendo recuerdos, observo que desde el ano de 1870 hasta el pre- 
sente, se ban contagiado en las salas de tifo del Hospital de Sn. Pablo, 
de Mexico, los Doctores Hinojosa, Flores, £gea y Galindo, Crespo, 
Pena, Calderon de la Barca, y Berrueco. 

Durante la epidemia de este afio, murieron vfctimas del tifo ; el ad- 
ministrador de ese hospital, seis estudiantes de medicina de los que alli 
concurrian y siete empleados : otros varios practicantes y sirvientes se 
enfermaron y salvaron, en una palabra, el contagio fu6 tan notable que 
bubo necesidad de cerrar la clfnica, en el citado asilo, mi^ntras dur6 la 
epidemia en su apogeo. 

£s tambi^n un hecho perfectamente observado, que entre los pobres 
el contagio del tifo es de lo mas frecuente. 

Al escribir estas lineas se me viene d la memoria el triste cuadro que 
presenci^ hace algunos afios, en una pobre familia : un nifLo de nueve 
ailos se enferm6 de tifo ; la madre, viuda, lo asistid con el mayor empeilo 
y san6 ; cuando estaba en la convalescencia, cay6 enfermo uno de sus 
hermanos; sigui6 la madre la penosa tarea de cuidarlo como al pri- 
mero, y tambi^n salv6 ; ent6nces la infeliz mujer d^bil y agotada por 
tanto sufrir y trabajar y desvelarse, se contagi6 y no tenienda fuerzas 
para luchar con la enfermedad, 8ucumbi6 dejando d sus hijos en la 
miseria. 

Como este caso pasan otros muchos. Con raz6n el Consejo Superior 
de Salubridad tiene dispuesto desde hace varios afios que los enfermos 
de tifo que no pueden ser asistidos convenientemente en sus casas sean 
Uevados al hospital — disposici6n cruel y dolorosa considerada indivi- 
dualmente pero necesaria para el bien comiin. 

Formando contraste con estos hechos, vemos que entre las familias 
acomodadas es muy raro el contagio. En comprobaci6n de este aserto 
podria citar no unos cuantos, sino muchfsimos casos. Ahora bien ^d 
qu^ es debida esta tan grande diferencia ? 

Sin duda que deben intervenir muchos factores ; pero en mi concepto 
uno de los principales es la condensaci6n, podria decirse, de los g^rme- 
nes del tifo en la atmosferada confinada que rodea d los enfermos. 

Debe influir y mucho para evitar el contagio, el cuidado que se tenga 
para desinfectar las ropas y deyecciones de los enfermos ; mas llama la 
atenci6n que dntes de los ultimos quince afios, cuando no usabamos los 
antis^pticos, sucedia casi lo mismo que ahora ; que entre la clase baja de 
la sociedad era mucho mas frecuente el contagio. 



26o EL TIFO EXANTEAfATICO, 

Acaso tainbi^n entre los pobres haya mayor receptividad porque eatin 
mal alimentados, y se agotan con los ciudados que exige la asistencia de 
los enfermos ; pero har^ notar que los medicos, practicantes, y sirvientes 
que estdn en contacto con los enfermos de tifo en los hospitales, aiin 
cuando coman bien y no haya en ellos causa especial de agotamiento, se 
contagian muy frecuentemente, como ya lo he dicho. Para mi si hay 
aglomeraci6n de enfermos, 6 en general si la ventilaci6n no se hace bien, 
el contagio es inminente. Hace pocos meses tuve ocasidn de coropro- 
barlo. 

En una buena familia, d quien de varias maneras persegufa la suerte 
se enfermd de tifo un j6ven que padecfa de una lesi6n a6rtica, y esto 
hizo que no pudiendo resistir su coraz6n el trabajo inmenso que le impo- 
nfa la fiebre, muriera d los 9 dias de la invasidn ; la madre se contagi6 y 
muri6 tambi^n; una hermana cay6 despu^s con la misma enfermedad 
salvando, y cuando estaba convaleciente, se contagiaron una tia 7 una 
enfermera, muriendo la primera y curAndose la segunda: en resiimen 
cinco enfermos y tres muertos. 

Estos grandes y excepcionales desastres pasaron en un entresuelo de 
techos bajos : nada se omiti6 de las precauciones recomendadas para evi- 
tar el contagio : se mudaba la ropa de los enfermos diariamente ; se le 
desinfectaba con soluci6n de bicloruro de mercurio al uno por mil ; se 
desinfectaban tambi^n las deyecciones; se evitaba tomar alimentos y 
bebidas en la pieza que ocupaba el tifoso, etc., y es de suponerse que si 
algun descuido hubo al principio, despu^s no se ha de haber omitido 
precauci6n alguna por el natural temor de enfermarse. Tampoco puede 
decirse que mas que contagio, fu6 infecci6n lo que hubo en este case, 
supuesto que hay varias viviendas en la misma casa« y las personas que 
las ocupaban bebian de la misma agua, y estaban sujetas en general d las 
mismas causas de insalubridad y sin embargo no se enfermaron. 

Queda pues como linico 6 al m^nos principal factor la falta de ampli- 
tud de las piezas y la defectuosa ventilaci6n por consiguiente. 

De todo lo expuesto, deduzco que para evitar la infecci6n y el conta- 
gio del tifo es preciso : 

1. Cuidar de que no haya en los lugares habitados, dep6sitos de mate- 
rias ani males susceptibles de entrar en putrefacci6n. 

2. Que debe tenerse un especial cuidado en que los enfermos de tifo 
no est^n aglomerados; que ocupen habitaciones amplias; y que se 
arregle la ventilaci6n de modo que se renueve facilmente el aire que los 
rodea, esto, se entiende sin descuidar la escrupulosa desinfeccidn de las 
deyecciones, de las ropas, y de todo lo que pudiera estar contaminado. 



PROCEEDINGS AND DISCUSSIONS AT THE TWENTY- 
FIRST ANNUAL MEETING, 

HELD IN 

Chicago, III., October 9-14, 1893. 



Monday, October 9, 1893. 

The Association met at the Memorial Art Palace, at n o'clock a. m. 
for the purpose of electing members. The Secretary presented a list of 
candidates for membership, who were duly elected. 

Adjourned. 

Tuesday, October 10, 1893. 

The Association met in Hall VII of the Memorial Art Palace, and in 
connection with the World's Congress Auxiliary constituted an Interna- 
tional Congress of Public Health. The meeting was called to order by 
the President of the World's Congresses of 1893, Hon. Charles C. Bon- 
ney, of Chicago. 

Divine blessing was invoked by the Rev. Dr. Parsons. 

Addresses were delivered by Mr. Charles C. Bonney, Mrs. Charles 
Henrotin, Dr. A. R. Reynolds, Dr. Eduardo Lic^aga, Dr. Sarah Hackett 
Stevenson, Miss Ada C. Sweet, and the President of the Association, Dr. 
Samuel H. Durgin, of Boston, Mass. 

On motion, the Association adjourned to Wednesday morning at 10 
o'clock. 



Wednesday, October 11, 1893. 
MORNING SESSION— 10 O^CLOCK. 

The Association was called to order at 10 a. m. by the President. 

The first business in order was the report of the Executive Committee, 
which was read by the Secretary. The report contained the names of 
gentlemen who were recommended for membership in the Association. 

On motion, the gentlemen whose names were read were elected mem- 
bers of the Association, the Secretary casting the ballot for them. 

The next thing in order was the report of the Treasurer, which was 
read by Dr. Henry D. Holton, of Brattleboro, Vt. 



262 PROCEEDINGS AND DISCUSSIONS, 

On motion of Dr. Lindsley, the report was received and referred to an 
Auditing Committee consisting of Drs. McCormack, Orvafiianos, and 
Bailey. 

Dr. Frederick Montizambert. — If there is no further business to be 
transacted, I move that the American Public Health Association do now 
adjourn, and that we proceed to the reading of the papers that are to 
come before the Congress. 

Dr. Albert L. Gihon. — I have a report to come before the Associa- 
tion, and I cannot see how it can come before the Congress, inasmuch as 
it is a report of one of the organic committees constituting the American 
Public Health Association. 

Dr. Joseph Sharp. — I move that the report be read by title, referred 
to the Congress, and then referred back to the Association. 

Dr. J. D. Plunket. — I think the position taken was agreed upon by 
the Executive Committee, although Dr. Gihon is practically right. 

The President. — I am strongly inclined to think that if we attempt to 
raise technicalities, we shall be in confusion and lose time, and it is much 
better for us to go on and to make our reports and papers to the Congress 
so called in the place of the Association. 

Dr. Albert L. Gihok. — If that is your decision, sir, I appeal from it. 
These reports are part of the proceedings of the American Public Health 
Association, which is now in session, and the reports of its committees 
are parts of its necessary work. I object, as chairman of my committee, 
to making the report at all unless it can be made to the Association. I 
have spent considerable time in getting the material for this report, and 
I desire to present it to the Association. 

Dr. J. N. McCoRMACK. — I ask for information. Is it not true that all 
the reports of the Congress and business transacted by the Congress will 
be published in the proceedings of the American Public Health Associa- 
tion just as if they came before the regular meeting ? All of the papers, 
discussions, resolutions, etc., are the property of the American Public 
Health Association, and will, I understand, be published in its transac- 
tions precisely as heretofore, and only by name do we call this meeting 
an International Congress of Public Health. 

The President. — Your idea, Dr. McCormack, is correct 

Dr. Albert L. Gihon. — Permit me to make a suggestion. Suppose 
this report is not received, how can the Congress act upon it } It has no 
right to act upon it. Therefore I prefer to make it to the Association, 
which alone can act upon it, the Congress having no authority of juris- 
diction in the matter. 

Dr. James F. Hibberd. — It seems to me that if this report is strictly 
private, and not one that should come before the Congress, it ought to 
be disposed of as matters were disposed of this morning ; but if it belongs 
to a wider range of public health, let it come before the general session 
of both the Congress and the American Public Health Association. 

The President then put the question of appeal from the decision of 



PROCEEDINGS AND DISCUSSIONS. 263 

the chair to the Association, and the result was as follows : Twenty were 
in favor of sustaining the chair, and twenty-six were against it. 

Dr. Albert L. Gihon, medical director U. S. navy, then read the 
report of the committee, as chairman, on "Sanitary and Medical Ser- 
vice on Board of Emigrant Ships." (See page 143.) 

It was moved that the report of the committee be received and referred 
to the Committee on Publication. 

(Seconded.) 

Dr. J. D. Plunket. — ^The recommendations, while seemingly radical 
in some particulars, are in the right direction. If this Association has 
any one object, it is to express a clear note on the subject of emigrant 
ships and how they shall be cared for. The points are covered in the 
chairman's report. They are pointed and clear, and there can be no 
mistake about what they mean. I therefore move, as an amendment, 
that the report be adopted instead of received. 

(Seconded and carried.) 

The President then put that part of the original motion referring the 
report to the Committee on Publication, which was also carried. 

Dr. John H. Rauch. — I move that we now adjourn as the American 
Public Health Association, and proceed to the reading of the papers that 
are to come before the Congress. 

Dr. J. N. McCoRMACK. — I have a report of about three minutes' length 
to read. It is the report of the Committee on Tuberculosis. 

Dr. J. N. McCormack, of Bowling Green, Ky., then read the report of 
the Committee on " Restriction and Prevention of Tuberculosis." (See 
page 208.) 

The President. — ^What disposition shall be made of this report ? 

Dr. C. N. Hewitt. — I move that the report be accepted and referred 
to the Committee on Publication. 

(Seconded and carried.) 

Dr. John H. Rauch then renewed his motion that the Association 
adjourn until 9 :3o a. m. Thursday, which was seconded and carried. 



The President. — The International Congress of Public Health will 
now come to order, and the first paper to be read is by Dr. John Wright 
Mason, of Hull, England, entitled " Notes on Cholera and its Manage- 
ment in Hull, England," which will be read by Dr. Hewitt, in the absence 
of the author. 

Dr. C. N. Hewitt. — I did not know that the paper was to be read this 
morning, or I should have brought it with me. It is in my satchel at the 
Grand Pacific hotel. 

The President. — We will now listen to a paper on " Tropical Diar- 
rhoea," T)y Sir Joseph Fayrer, of London, England, which will be read by 
Dr. Albert L. Gihon, in the absence of the author. 

Dr. Gihon then read the paper. (See page 33.) 



264 PROCEEDINGS AND DISCUSSIONS, 

The next paper read was entitled "Cholera Infantum and Its Treat- 
ment," by Dr. Manuel Septien, of Queretaro, Mex. (See page 39.) 

Prof. W. T. Sedgwick, of the Massachusetts Institute of Technology, 
Boston, addressed the Congress on the '^Origin and Dissemination of 
Typhoid Fever." (See page 237 for stenographic report). 

Dr. R. Icaza, of Mexico, read a paper entitled <^ Some Reflections on 
the Infection and Contagion of Typhus Exanthematicus." (See page 258.) 

Dr. Luis K Ruiz, of Mexico, followed with a paper on " Typhus Fever 
in the City of Mexico." (See page 253.) 

On motion, the discussion on the above papers was postponed until 
the afternoon session. 

The Association then adjourned until 2 p. m. 

AFTERNOON SESSIONS aCLOCK, 

The Association reassembled at 2 p. m., and was called to order by the 
President. 

The first thing in order was the discussion on typhoid fever. 

Dr. William Bailey, of Louisville. — I will occupy briefly the atten- 
tion of the Congress in connection with this subject, by giving in a con- 
cise way the history of an endemic in the city in which I live — Louisville, 
Ky. — where it was, I think, clearly traceable to milk supply. Many of 
you know it is a beautiful city, and in the most healthy, the most sanitary 
part of the city, it was observed that typhoid fever was unduly prevalent; 
as a local member of the State Board of Health of Kentucky, it became 
my duty to investigate this. Taking a limited area of from eight to ten 
blocks each way of the best part of the city, I found an unusual number 
of cases of typhoid. First, I investigated the water-supply, and found 
that the people were using hydrant-water, which was not different from 
that used in other parts of the city. From the engineer of the health 
department I obtained a map giving the condition of the streets, sewage, 
etc., and found I could attach nothing to them. Soon it became known 
to me that a number of these people were obtaining milk from one source. 
I investigated this, and traced forty-four cases of typhoid to one milk 
deliverer from a farm which in itself was unexceptional as to its condi- 
tion. The dairy, milk-house, and the cow-house were perfectly clean. 
Believing that typhoid was not communicable by milk itself, as the cows 
were not subject to the disease, I at once investigated the water that was 
used for cleansing the cans bacteriologically. It developed that the 
water used in washing the cans contained bacilli. I required that this 
water should be boiled before it was used for cleansing the cans. The 
man innocently remarked that he invariably washed the cans with boiled 
water, but rinsed them with cold water afterwards. About one thousand 
obtained their milk from this source, and forty-four cases out of this num- 
ber had typhoid fever ; and in the same district at least twenty thousand 
people were taking their milk from other sources, and there were only 



PROCEEDINGS AND DISCUSSIONS, 265 

nine cases out of twenty thousand that were afflicted with typhoid fever. 
I suggested to the people to boil their milk before using it. We had an 
instance of people who objected to discontinuing their milk from this 
source^ saying that they had used the milk for six years and knew it to 
be good. Finally, after the stricken families had ordered their milk dis- 
continued, the fever subsided in the district. 

Dr. C. O. Probst, of Columbus, O. — In regard to typhoid fever and 
its relation to polluted well water, the pictures which we have seen in our 
text-books for so many years, showing the pollution of the wells and their 
relation to the disease, are familiar to us. It has been shown by the 
Massachusetts state board of health, in connection with the Lawrence 
experiment station, that by sand filtration we can remove at least 99 per 
cent, of the germs found in sewage, but the wells are not always found in 
sand formation. I desire to speak of an endemic of typhoid fever which 
I investigated, showing that the disease may be communicated by pol- 
luted well water. In a little town in Ohio of 400 or 500 inhabitants, 
there were forty cases of typhoid fever with five deaths that had occiured 
in a period of about two months. In looking into the cause of the epi- 
demic, one of the striking features of the situation was a stone quarry 
located about half a mile from the centre of the village. Another feature 
of the situation was the geological formation on which this village was 
located. It consisted of a large bed of limestone, and this limestone was 
cracked in all directions, readily admitting a flow of water for a long dis- 
tance, as we discovered by experiment. The stone quarry, which was 26 
feet deep by measurement — a little deeper than the wells — ^was being 
pumped out when I arrived at the village. When it was completely emp- 
tied of water, the wells for three quarters of a mile were either entirely 
dry, or drained to a depth of two or three feet, there being very little 
water in the wells at that time. I found that they had had three cases of 
typhoid fever in the spring of this year. This happened only a month 
ago. The board of health, on the appearance of typhoid fever, ordered a 
cleaning up of the town. It was found that two barrels of night soil had 
been taken out and thrown into the stone quarry. This was discovered 
when the stone quarry was pumped dry. When the wells became lowered 
by the drouth there was evidently a flow of water from the stone quarry 
into the wells of the village, and the cases of typhoid fever commenced. 
I think many facts might be mentioned to show that it is possible in cer- 
tain sections, where we have a peculiar geological formation, for the wells 
to be polluted by cesspools or privy vaults, thus causing typhoid fever. 

There is one other question in connection with the disease that might 
be mentioned, and that is as to whether there is any danger in the body 
of a person who has died of this disease. Some six years ago rules and 
regulations were sent to the various state boards of health, asking them 
to recommend any changes necessary, and among other things was the 
requirement that all persons having died of the disease shall be enclosed 
in hermetically sealed caskets, and transported to the railroads. Our 



266 PROCEEDINGS AND DISCUSSIONS, 

physicians do not believe there is any danger in connection with the body 
of a person who has died of typhoid fever. They have been clamorous 
to have this clause omitted, so that now we consider the body of a person 
having died of typhoid fever harmless, and it is unnecessary to adopt 
such precautions. I would like to know what the opinion of the other 
members is in regard to this point. 

Dr. Charles N. Hewitt, of Red Wing, Minn. — I am glad to join my 
friend in his protest against the sweeping adoption of the views which 
were sustained by Professor Sedgwick this morning. It looks to me like 
a very simple problem. I suppose Professor Sedgwick would be one of 
the last to deny the specific cause of enteric fever, and I wish the word 
typhoid was abolished. Enteric fever is due to a specific microbe, and 
unless he takes the homeopathic view of the effect of dilution, I should 
think it would be beyond question, that through a hole in the ground in 
close proximity to a well, which is receiving the excreta of a family of five 
or six victims of enteric fever, the inhabitants of the village or town may 
be infected. Oftentimes in country villages we find the surface deposit 
of such excreta flowing into the well. It seems to me we might take that 
water and get an extract from it the same as we get tuberculin, and call 
it entering classing it among other organic remedies. It is too much to 
ask those of us who have been fighting this disease for many years to 
believe that we must go to the rivers of our country for the origin of this 
specific disease. If that is the case, why should enteric fever be limited 
to certain months in the year? Why should it obtain in climates in 
October, and then decline before freezing sets in ? The intimate relation 
of enteric fever and the pollution of wells has been demonstrated over 
and over again, and is apparent to all of us. We have this disease from 
farm to farm, where the wells are a mile and a mile and a half apart, and 
the only source of water-supply is the well. 

It is not desirable to enter into a lengthy discussion of this matter, but 
we should properly state the facts. We should acknowledge that there 
is more than one way by which enteric fever can be disseminated. Dirty 
fingers, etc., as mentioned by Professor Sedgwick, no doubt play an 
important part in the causation of the disease in some cases, but other 
and equally important factors should not be overlooked. 

Prof. W. T. Sedgwick. — Those of you who heard what I had to say 
this morning will, I think, bear me out when I say that I remarked that 
water, milk, and secondary infection were probably the principal avenues 
along which typhoid infection travels. Dr. Hewitt is right when he says 
that I would be the last to deny that there is probably some specific 
microbe — ^using that word in its etymological sense, some small living 
thing, whether it be the Ebert bacillus or not — which causes typhoid 
fever. I particularly said that I believed some typhoid fever has come 
from wells. The gentleman who was speaking when I came in was tell- 
ing about some cases in which the soil was full of cracks and fissures. 
In cases like that, it seems to me, there could be early direct contamma- 



PROCEEDINGS AND DISCUSSIONS. 267 

tion of the well ; but where the soil is sandy or loose, so that filtration 
can go on, such as we have when a farmer manures his field, there comes 
in the destruction of organic matter, as has been demonstrated at the 
Lawrence experiment station. Not only are pathogenic germs, but all 
other germs, removed by their passage through the soil. Even taking 
the lurid picture which Dr. Hewitt has drawn of a lot of fecal matter 
deposited near a well, let us suppose for a moment that these microbes 
were not noticeable. How many of them do you suppose would survive in 
that putrefying mass to get through into the well ? The fact is, that these 
organisms have their life-history, their favorable and unfavorable environ- 
ments, and we have been studying these environments in the last five 
years and have learned that some bacteria die rapidly under conditions 
which were formerly supposed to be favorable for their growth. It is a 
fact the typhoid bacillus dies out quickly ; it dies out very quickly under 
unfavorable circumstances, although in some instances it may live a long 
time. It does not follow that if you put a lot of decomposable material 
in a hole in a farm, in which there are young fishes or living things, that 
they would be suifocated, fermented, and putrefied, and would not pass 
through. So it is with the pathogenic germs. The facts are, that we 
have to come from glittering generalities to actual specific experiments. 
We know what the life of many of these bacteria is, how short it is. We 
know that unfavorable influences result, and we have had to revise our 
old ideas in the light of the actual experiments carried on. At the same 
time, in a general way, I agree entirely with the speakers whom I have 
listened to. 

I have no doubt whatever that a good deal of typhoid fever comes from 
polluted wells, but with regard to isolated farm cases, I should like to 
say this : If you will take an isolated country district, with a little manu- 
facturing town in one comer of it, and find out how many cases of typhoid 
have arisen through polluted wells, you will be surprised. I have tabu- 
lated towns having less than one thousand population, and have found 
the rate from typhoid fever for many years, and it does not stand as high 
as is the case in many of the manufacturing villages. On the other hand, 
if you examine a few cases which you find there, you will ascertain that a 
large majority of them have been imported. A son or daughter of the 
family has gone to the city and brought it to the old home. The fact is, 
when we examine these cases carefully and study each case individually, 
look at the other side, we find a lot of objections ; not that there is any- 
thing so very revolutionary in all this, but it gives us some new points of 
view. 

In speaking about the wells, I may have over-stated the matter in the 
course of my rapid speech, but I do not think so, and so, believing as I 
do what I said, I should reaflirm it with added strength, saying that it is 
based not merely on personal investigation of these cases, but also upon 
laboratory experiments with pathogenic bacteria. 

In a paper which is to be read to-morrow, Mr. Fuller will describe at 



268 PROCEEDINGS AND DISCUSSIONS. 

some length the experiments which have gone on in the removal of path- 
ogenic bacteria from drinking-water by sand filtration. He will refer to 
the results of such filtration, and after they have been brought forward 
it will become evident to those who believe in the microbian theory of 
the disease that we have many conditions to deal with which we have 
not heretofore altogether understood. 

Mr. Allen Hazen, of Lawrence, Mass., read a paper entitled, "The 
Sewage Disposal Problem in American Cities." (See page 44.) 

Dr. U. O. B. Wingate, of Milwaukee, Wis., read a paper entitled " The 
Collection and Distribution of Animal Waste of the City of Milwaukee." 
(See page 49.) 

Col. W. F. Morse, of New York city, read a paper entitled " Disposal 
of Garbage and Waste of the World's Columbian Exposition." (See page 

Dr. Sarah H. Brajrton, of Evanston, 111., read a paper entitled " How 
Can Women Promote Public Sanitation ?" (See page 178.) 

Lady Priestly, of England, contributed a paper on " The Progress of 
Sanitary Knowledge Among the Women of England," which was read by 
Mrs. Henry Wade Rogers, of Evanston, 111. (See page 172.) 

Dr. John Wright Mason, of Hull, England, contributed a paper entitled 
" Notes on Cholera and Its Management in Hull," which was read by 
Dr. Hewitt, in the absence of the author. (See page 25.) 

On motion, the Association adjourned till Thursday morning. 



Thursday, October 12, 1893. 
MORNING SESSION-^ :so O'CLOCK. 

The Association was called to order at 9 : 30 a. m. by the President. 

The Secretary read a further report from the Executive Committee, 
recommending new members. 

On motion, the rules were suspended and the Secretary instructed to 
cast the ballot of the Association for the election of the new members, 
which he did, and they were declared duly elected. 

The Auditing Committee reported through Dr. J. N. McCormack that 
it had examined the accounts of the Secretary and Treasurer, and found 
them correct. 

On motion, the report was adopted. 

The Secifetary then called the roll of the Advisory Council. 

Dr. Henry P. Walcott, of Cambridge, Mass., offered the following reso- 
lution regarding national legislation, which was supported by Dr. Henry 
B. Baker, and adopted : 

Resolveot That the American Public Health Association again urge upon congress the 
necessity of the appointment of some officer with general sanitary authority in connec- 
tion with the national government. 



PROCEEDINGS AND DISCUSSIONS, 269 

That the functions of such an authority are of sufficient importance to demand the 
ezdusive attention of the best instructed sanitarian. 

That such authority should be enabled, from time to time and under proper regula- 
tions, to secure the advice and codperation of the state boards of health. 

The reading of papers before the Congress was then proceeded with, 
and the first paper read was by Dr. D. £. Salmon, chief of the bureau of 
animal industry, Washington, D. C, entitled " Tuberculosis and the Food 
Supply." (See page 196.) 

Dr. Manuel Carmona y Valle, of Mexico, followed with a paper entitled 
" Syphilitic Infection as a Vehicle of the Communication of Tuberculo- 
sis." (See page 204.) 

Dr. Manuel Gutierrez, of Mexico, read a paper on " The Influence of 
Habitations in the Propagation of Tuberculosis." (See page 202.) 

DISCUSSION. 

Dr. Lawrence F. Flick, of Philadelphia. — I would like to open the 
discussion on this subject by saying with regard to the papers in the 
order in which they were read, especially the first paper on the question 
of what influence milk and meat play in the spread of tuberculosis, that I 
am under the impression that there has been an exaggerated idea in the 
past as to the part that both milk and meat play in the spread of this dis- 
ease, and, as indicated by one of the papers, we are coming to be more 
conservative. It seems to me it is very important to speak of the exact 
truth and to announce nothing but scientific knowledge on this subject, 
because there is great danger of frightening people and doing injury by 
giving an exaggerated idea of the dangers from using milk and meat. I 
have studied the literature on this subject and have made clinical obser- 
vations upon it for years, and I am more and more convinced that milk 
and meat infection plays a very small rble, I have looked up for years 
the literature on the subject, and I have not seen an authenticated case 
where the disease has been conveyed by either of these two articles of 
food. In my clinical observations I have observed cases in which I had 
reason to believe that the disease was conveyed by taking tuberculous 
milk, but I am satisfied that other elements of infection are so much 
greater that they ought to be placed in the foreground. 

In considering this question it must be borne in mind that the taking 
of tuberculous milk and meat can give infection of the lungs as well as 
infection of the bowels. There seems to be an erroneous idea that in 
order to get tuberculosis of the lungs we have to inhale the bacillus. If 
you recall your anatomy and physiology you know that the shortest way 
into the circulation is by the stomach, and that infection of the system 
through the stomach will give tuberculosis of the lungs. All of the new 
blood of the tissues carried into the system through the lacteals, through 
the chyme, liver, etc., goes through the lungs before it goes to any other 



270 PROCEEDINGS AND DISCUSSIONS. 

portion of the body. Any bacilli that float in the blood must be arrested 
in the lungs before they are arrested in any other part of the body. 

The paper on the question of syphilis being a vehicle of conveying 
tuberculosis is, indeed, a most interesting one, and yet I am disposed to 
think that possibly the case upon which this paper is based may have 
been a case of tuberculosis from the beginning. There was a time when 
I believed in syphilitic phthisis, but I have long since changed my mind 
upon the subject. I do not believe now that there is such a thing, and I 
am inclined to think that the case upon which this paper is based was 
really a case of tuberculosis from the outset. 

The influence of dwellings in the spread of tuberculosis is a very 
important one, and yet I cannot help but feel that the essayist upon that 
subject has not quite grasped the idea — has not given us die true cause 
of dwelling infection. Mexico has not as large a mortality from tubercu- 
losis as the United States, I think, for quite a different reason than the 
one given in the paper. At the time that Mexico was colonized, and 
indeed ever since, there have been precautions against the spread of 
tuberculosis, and Mexico never has had anything like the mortality that 
the United States has. I do not believe the climate has had much to do 
with it, because we have equally as good climates in the world as that of 
Mexico, that have a high mortality rate from this disease. Dwellings — 
it makes no difference how well regulated they are for sunlight and for 
air — when they once become infected, will convey the disease to others ; 
whilst dwellings which have invited cases of tuberculosis — no matter how 
bad the sunlight and air — still remain free from the disease. I have 
studied this particular phase of the subject very carefully, and I have 
seen the most unsanitary houses occupied by the most unsanitary people 
in which there was not a death from tuberculosis for many years, while 
houses occupied exactly under the same sanitary surroundings and the 
same class of people living in them have had repeated deaths from the 
disease. 

The influence of dwellings in the spread of this disease is probably the 
most important factor we have to consider ; but an important thing for 
sanitarians to take into consideration is this : Let us disinfect carefully 
all houses which have had occupants suffering from this disease, and 
thereby prevent it from spreading to subsequent occupants. If this one 
factor was removed, more would be accomplished in the prevention of 
this disease than by any other method that could be established. 

Dr. William Oldright, of Toronto. — I would like to ask one or two 
questions of the reader of the first paper, whom we consider high author- 
ity in this matter. Last year we had a discussion at Niagara Falls on 
the subject of tuberculosis, and one of the questions that was asked was 
with regard to the susceptibility of various breeds to tuberculosis. It 
has been generally thought that Jersey cows were more suspeptible to it 
than others. It was there stated that this was not the case, that tubercu- 
losis was more or less common in all of the breeds, and the reason of it 



PROCEEDINGS AND DISCUSSIONS. 27 1 

is not mentioned. It is believed by some that there is a certain weak- 
ness or want of vitality incidental to the process of breeding in. I would 
like to hear the result of Dr. Salmon's observations on the subject. 

Then again, the doctor told us that the milk of tuberculous cows was 
rendered less dangerous by being mixed with that of other cows. I have 
heard that statement before. 

I believe we are told that the bacillus of tuberculosis is one of those 
bacilli that contains spores, and that it is more difficult to destroy. Some 
doubt has been thrown upon that subject, and I would like to hear from 
the doctor regarding that point. Finally, the doctor stated that unless 
the disease existed in the milk tubes there was not as much danger as if 
it did not exist in them. Is it possible for a man to determine from 
inspection merely, without the use of tuberculin, whether the disease is 
absent in the milk tubes or not ? 

Dr. I. N. QuiMBY, of Jersey City, N. J. — I would like to ask Dr. Salmon 
if I understood him correctly, that the only two methods by which tuber- 
culosis was engendered or produced were by food and inhalation of the 
atmosphere freighted with the bacillus of tuberculosis. Am I right ? 

Dr. D. E. Salmon. — Yes. 

Dr. Quimby. — Then, I would take emphatic issue with you. If that 
is the case, our medical literature will have to be rewritten, because now 
our text-books on tuberculosis give us so many other reasons, such as ill 
health, broken down tissue, anaemia, or variety of diseases producing 
that peculiar condition of the system in which it makes persons specially 
susceptible to the disease. I cannot think that the ordinary health of 
the body is going to be in any way affected by an ordinary tubercle 
bacillus that may be found in the atmosphere. It seems to me that we 
must consider the cause of the disease upon a different basis altogether, 
more particularly if we believe such writers as Flint, Fagge, and others, 
because they give a variety of causes of tuberculosis outside of the fact 
that we have it from the atmosphere. We have it especially from milk, 
it being one vehicle by which it is conveyed. There is one important 
point that we must remember, or should not forget, and that is, it has not 
been decided yet, even by the best microscopists, how many to the square 
inch of bacteria are pathogenic. Until we decide that, how are we going 
to say if we see a cow that has tuberculosis, that the tubercle is an inno- 
cent one 1 It may be a germ- or a spore-producing one, and until we find 
this out we certainly should not slaughter the cow. If a cow is affected 
with tuberculosis, we should not proceed to kill it until we have tried 
other remedies which are known to destroy. As Dr. Sternberg said last 
evening in his lecture on germs, high altitude is in harmony with the 
paper read by the gentleman from Mexico. High altitude, sunlight, and 
running water : turn a cow into that kind of pasture and very few tuber- 
cles will be found in the milk; but if we should go to the enormous 
expense of establishing a law which would cause millions of animals to 
be slaughtered we would injure our position. Tubercles having been 



272 PROCEEDINGS AND DISCUSSIONS, 

found in the milk of a certain cow, the cow has been taken from its usual 
pasture, put on an elevated plain where there is plenty of sunlight and 
pure air, and the tubercles in the milk disappear. We must be cautious 
in suggesting any measures which would cause us great difficulty. 

The second paper in reference to hotels and rooms, in excluding the 
air and sunlight from them, is worthy of the highest consideration of this 
body. We should make it so unpopular for architects and contractors as 
not to build these dark rooms where electricity and sunlight never appear. 
We should try to remedy that part of the architectural structure. 

Dr. Joel W. Smith, of Charles City, la. — I desire to add my testimony 
in regard to the effect of our habitations upon the spread of tuberculosis. 
I have studied this question very carefully for years, and I have come to 
the conclusion that a damp house is a dangerous one. It is necessarily 
a cold house, and one which favors the development of tuberculosis. We 
have in a highly finished house, for example, a family moving into it 
They are a successful family to all appearances. One generation will do 
well ; trees will grow up around the house and overshadow it, and in a 
comparatively short period, of say twenty years or less, the house be- 
comes unhealthy. It is one in which you can write your name on many 
articles of furniture contained therein. I have seen many instances of 
that kind, where families in the course of generations have become ex- 
tinct, and it is sometimes very difficult to trace the cause of ill health in 
these cases. We all think we want a few trees in the country villages 
and smaller cities around our dwellings, but it is the abuse of the thing, 
and so many trees render our dwellings damp, cold, and unhealthy. To 
remove the cold in a measure, we make the room warm, and that disposes 
also of impure air. Whether the medical practitioner is responsible for 
these things, or whether we ought to turn our attention in a missionary 
direction, is a question I think that we can profitably consider. It seems 
to me that if we could have a sanitary engineer to regulate the amount 
of trees in villages and cities, much of the dampness and ill health could 
be remedied. 

Dr. D. E. Salmon (closing the discussion). — In the discussion there 
have been several prominent points raised, which I shall refer to very 
briefly, because I know how valuable your time is. There was one point 
raised by the gentleman who made the first remark in the way of discus- 
sion, which is a very important one, and I would like to ask your atten- 
tion to that first, namely, as to whether tuberculosis of the lungs may 
arise from the ingestion of tuberculous food. A few years ago I was con- 
fident in my opinion that such was the case, but the more I have studied 
the matter, the more doubtful I am about it, and I find that other people 
who have made original investigations are also in doubt. It would seem 
to be a very easy matter for the tubercle bacillus to penetrate from the 
stomach to the lungs and set up tuberculosis of the lungs, and not have 
tubercular lesions in other parts of the body; but when we study the dis- 
tribution of the diseased germs throughout the body, we find they have 



PROCEEDINGS AND DISCUSSIONS. 273 

certain channels by which they move from one portion of the body to the 
other. When an animal, or a man, is infected by the ingestion of tuber- 
cular food, we are apt to find the initial lesions of the disease in the 
mesenteric glands, in the lymphatic glands of the abdominal cavity, and 
we find that the disease is apt to progress by the lymphatics from that 
point. The means of infection is one of the most practical points which 
we have to determine at the present day, and we need to have further 
investigations to determine just what proportion of tuberculosis of man- 
kind is caused by infected food, and what proportion is caused by the 
infected air. The way to get at that is by careful post-mortem examina- 
tions, to determine whether the initial lesions of the disease are in the 
lymphatic glands of the abdominal cavity, or whether in the lungs or the 
bronchial glands. 

In regard to some other questions, I did not say anything upon the 
prevalence of tuberculosis in cows. If a herd of cows has tuberculosis, 
whether Jersey or short-homed cows, the question is, how to deal with 
the herd. As a matter of fact, there is no difference in breed. Jersey 
cows have been accused of having a predisposition to tuberculosis. It 
arises from the fact that they have been valuable animals, and tubercular 
Jersey cows have been retained just as long as there was a dollar's worth 
of profit in them. 

With reference to the danger of polluted milk, it is a general rule run- 
ning through all the contagious diseases that the smaller the number of 
germs taken into the body, the less danger there is of infection being 
caused. If you dilute the virus of most of the contagious diseases, as I 
was one of the first to show by my investigations of chicken cholera, 
where the virus is very contagious you reach a point where the disease 
is not produced by inoculation. It is just the same way with tuberculo- 
sis. If you dilute infected milk to a certain degree, you reach a point 
where it is no longer dangerous. It is an open question between these 
two extremes. 

In regard to the spores of the tubercle bacillus, so far as my opinion 
goes, I have never been able to determine that the bacillus does form 
spores. I think it does not. It must be considered an open question 
until further investigations are made. 

The reason that there is more danger from tuberculosis in the udder 
than when it is in other parts of the body, arises from the fact that the 
tubercles are found in greater numbers in the udder and are apt to be 
excreted with the milk. 

In regard to the remarks of Dr. Quimby, I will not insist on the point 
that tuberculosis is only caused by one kind of germ in animals, and 
caused by the identical germ in man. When you have a case of tuber- 
culosis in a cow, there is no reason why you should stop to inquire 
whether the bacillus is infectious and pathogenic or not. If you have a 
case of tuberculosis, you know the animal is not fit to furnish milk for 
general supply. 



274 PROCEEDINGS AND DISCUSSIONS. 

In regard to the expense, I am sure that if we began in a wholesale 
way to kill off all the tuberculous cows, it would be enormous, as also the 
responsibility. That is not necessary from a practical point of view. 
For instance, the health department of the city of Chicago have a regu- 
lation that there shall be an inspection of the herd which furnish milk to 
the city, and if they find that any of the herd are tuberculous, they can 
refuse to allow the sale of that milk in the city. They have full power 
to do that. When such milk comes from the state of Indiana to the city 
of Chicago, by general cooperation between the general government and 
the health department of the city of Chicago its sale can be prohibited, 
and the owner of that herd can be compelled to do something with those 
cows to avoid the danger before he is allowed to ship the milk into the 
city. In that way the chief expense is the matter of inspection, and that 
is not so great. It is perfectly practicable to begin some measures to 
prevent the sale of infected milk. 

This paper was also discussed by Drs. Lic^aga and Orvafianos. 

Mrs. Ellen H. Richards, of the Massachusetts Institute of Technology, 
Boston, read a paper entitled " The Prophylactic and Therapeutic Value 
of Food." (See page i6i.) 

Dr. Angel Contraras, of Pueblo, Mex., read a paper on " Hygiene of 
Hair Dressing and Barber Shops." (See page 8i.) 

A paper by Dr. Ernest Hart, of London, entitled " Objects of the Na- 
tional Health Society of London," was read by title, and, on motion, 
referred to the Committee on Publication. (See page 71.) 

On motion, the Association adjourned until the afternoon. 

AFTERNOON SESSION— 2 O'CLOCK. 

The Association reassembled at 2 p. m., and was called to order by 
the President. 

The first paper read was a joint one by Dr. A. R. Reynolds, health 
commissioner of Chicago, and Mr. Allen Hazen, chemist to the water 
department of the World's Columbian Exposition, entitled " The Water- 
Supply of Chicago." (See page 146.) 

Mr. George W. Fuller, biologist to the Lawrence experiment station, 
Massachusetts, read a paper entitled " Removal of Pathogenic Bacteria 
from Drinking-Water by Sand Filtration. (See page 152.) 

Dr. A. Gavino, of Mexico, followed with a paper on "The Potable 
Waters of the Country Presenting Many Dangers." (See page 231.) 

DISCUSSION. 

Dr. Benjamin Lee, of Philadelphia. — I do not propose to discuss 
these interesting papers, but simply to point out a source of error in a 
statement contained in the first paper read by Dr. Reynolds with regard 
to the prevalence of typhoid fever as the result of the Centennial Exposi- 
tion. The statement was made in this connection, that we find persons 



PROCEEDINGS AND DISCUSSIONS. 275 

who partake of polluted water, and who are not accustomed to the use of 
that water, are more liable to have typhoid fever than those who are 
habituated to its use. That statement may undoubtedly be true ; I do 
not wish to question it, but as a corollary from the Centennial Exposition 
it cannot be deduced. The fact is, that in just so much as this magnifi- 
cent exhibition, which we have the privilege of attending at present in 
the city of Chicago, exceeds the Centennial in the beauty of its buildings 
and in its architectural display, by just so much does it exceed the Cen- 
tennial in its sanitary arrangements. I may say this without blushing for 
Philadelphia, because seventeen years have elapsed since the Centennial, 
and it is fair to suppose that Chicago could make use of the immense 
advancement which has been made in hygienic science and art since that 
time. The fact is, the water-supply of the Centennial was a special water- 
supply invented simply for the Ebcposition grounds ; that it was drawn 
from the river Schuylkill which received the sewage of the Centennial 
grounds ; that just at the point whence the water-supply was drawn the 
current stream was unusually sluggish, and the consequence was that the 
visitors to the Centennial, among whom, of course, was a large proportion 
of the population of Philadelphia, were drinking water which was more 
polluted than the water which Philadelphians were accustomed to, 
although unfortunately they were accustomed to very bad water. From 
the fact that many cases of t3rphoid fever occurred in the Centennial year 
in Philadelphia, we can deduce nothing from it as regards polluted water. 
I might say also that it is very unsafe to deduce any general results from 
the death rate in Philadelphia, as compared with the use of water, for we 
have there two sources of water-supply, the Schuylkill and the Philadel- 
phia rivers. The stream is polluted by other streams and populations 
residing many miles above the city. The Delaware river is polluted by 
the city of Philadelphia itself, which discharges its sewage into it, though 
the incoming tide sweeps back a large proportion of the sewage received. 
When the Delaware water is used to a large extent we are drinking a 
much larger proportion than when the Delaware water is used to a small 
extent. We are getting rid of the Delaware water gradually, but are still 
using it to some extent. As we have two sources of water-supply, one of 
which is polluted to a greater extent than the other, it is impossible to de- 
duce conclusions about the death rate of Pennsylvania at any special time. 
Dr. J. E. MoNjARAS, of San Luis Potosi, Mex. — Everybody knows 
that the importance of the results obtained in these practical studies, so 
ably outlined by Mr. Fuller, is based on a knowledge of the methods 
employed in them. The German method, finished in from three to five 
days, loses many bacteria, for the reason that a great many bacteria 
develop after ten, fifteen, and even twenty, days. In the second place, 
the germs do not always grow in gelatine. That is the reason why it is 
necessary to employ only the method of Miquel, who occupies thirty days 
in his experiments and makes them both in agar-agar, gelatine, and 
bouillon. 



276 PROCEEDINGS AND DISCUSSIONS, 

Mr. George W. Fuller, of Lawrence, Mass. — I would like to state 
that as far as our experience goes, we find there is no line of work to 
which bacteriology has been applied in which the results are more satis- 
factory than in the determinations of the number of bacteria before and 
after filtration. The percentages on the diagrams represent the number 
of bacteria found in the effluent. 

Prof. W. T. Sedgwick. — In confirmation of what Mr. Fuller has said 
with regard to the practical application of all this work, I really want to 
emphasize what he said in his paper, namely : that a filter of two and a 
half acres is to-day in practical operation for the city of Lawrence — a city 
which has had the highest death rate from typhoid fever of any city in 
Massachusetts. It has been in operation now about two weeks, and 
already the reduction of the bacteria in the river water supplied to the 
filter is, as Mr. Fuller has said, as much as 80 per cent. As a matter of 
fact, it is more than that. It was at least 80 per cent, the first two weeks, 
and it required three weeks to keep such a filter in good condition. I 
mention this for the benefit of the members of the Association who may 
hereafter be interested in this practical experiment. Here is a city of 
fifty thousand people afflicted with typhoid fever ; a filter has been put in 
operation, constructed merely of sand, and at the end of two weeks it is 
removing between 80 and 90 per cent, of bacteria. At the end of three 
weeks it will have removed 98 per cent, of the bacteria. That is what 
the London filters do most of the time, as has been shown by Mr. Percy 
Franklin in 1886 and 1888. There seems to be no doubt that by means 
of such filters cities may defend themselves effectively against the inva- 
sion of typhoid fever on a large scale. As this is the first filter of the 
kind, not only in the United States but upon the Western continent, its 
results may well be watched hereafter with a good deal of interest. 

Mr. Fuller. — I am just in receipt of a letter from my assistant saying 
that the filter is removing, on an average, 98 per cent, of bacteria. 

A paper by Dr. C. N. Hewitt, of Red Wing, Minn., entitled " Sanitary 
Organizations, National, State, and Municipal, in the United States from 
the Standpoint of an Executive Officer," was read by title. 

Dr. Eduardo Lic^aga, of Mexico, read a paper entitled " Statement of 
Scientific and Experimental Data for the Establishment of International 
Maritime Police." (See page 137.) 

Dr. Domingo Orvananos, of Mexico, read a paper entitled " Difficulties in 
the Practice of Quarantine in Some of the Mexican Ports." (See page 104.) 

Other papers were read, as follows : 

" The Canadian Quarantine System," by Dr. Frederick Montizambert, 
of Quebec, Can. (See page 92.) 

" Quarantine System of Texas," by Dr. R. M. Swearingen, of Austin, 
Tex. (See page in.) 

" Quarantine," by Dr. S. P. Olliphant, of New Orleans, La., which was 
read by Dr. Salomon, of New Orleans. (See page 107.) 

These papers were then jointly discussed. 



PROCEEDINGS AND DISCUSSIONS. 277 

DISCUSSION ON QUARANTINE. 

Dr. Domingo OrvaJ^anos, of Mexico. — In discussing the papers on 
quarantine, I desire simply to say that Dr. Swearingen is right in regard 
to what he said about our laws in Mexico, and I promise him, in the 
name of the president of the republic of Mexico, that we will improve the 
condition of the frontier at once, not only for our own convenience, but 
for the convenience of the United States. 

Dr. Henry D. Holton, of Brattleboro, Vt. — There is one point that 
struck me forcibly when Dr. Montizambert was giving a history of quar- 
antine in Canada, and that is, the system seems to me to be so efficient 
and thorough that it should be made known to the public. As physicians 
and sanitarians we have known something about it for a good while, and 
we have appreciated the work that has been done by the sanitarians of 
Canada. You know in every state, especially bordering along the Cana- 
dian line, that the moment an epidemic of cholera is started in Europe, 
or any great number of cases of small-pox occur in any Canadian city, 
there is great fear by the people that the Canadian quarantine will not be 
sufficient to protect us. I think the general public in the United States 
should be disabused of that, and it can only be done by us as individuals 
in our local capacity among our people at home, by calling their attention 
to the fact, if we so choose, in the public prints, that we know what is 
being done in Canada is as efficient as anything that is being done in 
this country. 

Dr. C. N. Hewitt, of Red Wing, Minn. — I desire to supplement the 
remarks of Dr. Holton by saying that we in Minnesota have been aware 
of the efficient quarantine system in the Dominion of Canada, and that 
we have never had any hesitancy in trusting inspection by Gross Isle ; 
but there has been other inspection service in Canada which we did 
not trust. The matter is so concentrated now, however, that we feel 
safe. In the last year from seven hundred to eight hundred emigrants 
have come through into Minnesota bearing the combined endorse- 
ment of the Canadian and our own governments, and their names, 
through the courtesy of the marine hospital service, have been served 
upon me. With the active cooperation of the local force, we have an 
improved system which enables us to keep track of these men, women, 
and children, and out of the number mentioned there were only two cases 
of sickness that have been reported that we are aware of. There were 
two cases of diarrhoea. One man died on the way from the " Soo." It 
was very little trouble to prove that it was nothing serious. Incidentally 
the man was inspected by the health commissioner of St. Paul, and every 
person that came with him was traced to their location and disposed of. 

The point on which we agree is this, that we are infinitely more alarmed 
with regard to the danger of small-pox, diphtheria, or scarlatina coming 
through New York harbor than cholera. The other diseases are slaugh- 
tering our population every day, and we want to keep them out. We are 



278 PROCEEDINGS AND DISCUSSIONS. 

satisfied that the disinfecting system adopted by the Canadian govern- 
ment in disposing of all baggage through disinfecting chambers meets 
our ideas exactly. Canada has got the lead on us, and a pretty big one, 
too. 

Dr. William Oldright, of Toronto, Canada. — The remarks made by 
Dr. Holton are very appropriate, and if we are to make any advance in 
sanitary reform, especially in protecting the inroads of contagious diseases, 
we must act together. It is very discouraging and dampens the ardor 
of health officers if they find that health officers in an adjoining city are 
suspicious of them when they are doing good work. During the earlier 
years of the existence of the Ontario Board of Health, we had delegates 
who went to various meetings, and through our own provincial board 
gave an account of what took place at these meetings. If the various 
provinces and states would send an account of the work done here, and 
the systems adopted were given in each of these reports, it would help 
us materially in that we would know what is being done elsewhere. 

With regard to the remarks of Dr. Hewitt, emphasizing the fact that 
too little attention is paid to other contagious diseases which are yearly 
killing more people than cholera, I would state, in our province the mat- 
ter of such contagious diseases as scarlet-fever, diphtheria, and small-pox 
is managed by the several municipalities. The provincial board, and 
the provincial boards of other provinces, have an overseer, who sees that 
the municipalities do their work ; but the matter of disinfection, isolation, 
and so on, is left to be carried out by the municipalities, the provincial 
board watching to see that the work is done. 

Dr. C. N. Hewitt. — As there is no representative here from Manitoba, 
I ought, in justice to him, as an American health officer to say a few 
words in his behalf. This spring small-pox got into the province of 
Manitoba, and I was permitted to go and assist the provincial board of 
health in dealing with it, and to also provide for the protection of our 
own state — Minnesota. So I found a new organization, recently gotten 
together. The members of it worked in such an admirable way that two 
or three centres of infection were overcome ; a number of emigrants were 
isolated and dealt with, and not a single case out of over a hundred emi- 
grants badly infected escaped their vigilance. The whole thing was dis- 
posed of thoroughly. I found the cooperation between the provincial 
board and the local boards was exactly the same as we are fortunate to 
have in our state. It was a good piece of work, admirably done, and we 
in Minnesota feel grateful for it. 

Dr. Henry B. Baker, of Lansing, Mich. — I wish to add my testimony 
to what has been said in commendation of the work done in the Dominion 
of Canada in the disinfection of baggage and emigrants. I wish also to 
emphasize what has been mentioned by Drs. Hewitt and Oldright, namely, 
the importance of having in view those other diseases that are of more 
consequence to us in the North-west than cholera. I express the hope 
that the Dominion of Canada will continue in succeeding years to do what 



PROCEEDINGS AND DISCUSSIONS, 279 

it has done this year with reference to cholera, and add the methods 
applicable to those other diseases. I understand from Dr. Montizambert 
that they have had in view mainly cholera and the methods of disinfec- 
tion. For the disinfection with reference to diphtheria and consumption, 
two of our most important diseases, something more is needed. I ex- 
press the hope that Canada will continue to add that method of disinfec- 
tion to the containers which they have applied to the contents, and which 
are more liable to be infected with sputa than the contents themselves. 
They disinfect the contents by steam, and the containers by another 
process. To recapitulate : There are other diseases from which we wish 
to be protected, and I trust that Canada will continue in years to come 
to disinfect with reference to the other diseases that have been men- 
tioned. 

The President. — I would like to hear from Dr. Montizambert in re- 
gard to the degree of heat and length of time to which baggage is sub- 
jected, and the effect upon the clothing. 

Dr. Frederick Montizambert. — To answer that question fully, it will 
be necessary for me to briefly describe the process of disinfection, etc. 

Dr. James F. Hibberd, of Richmond, Ind. — Will you also state whether 
the contents of the pieces of luggage are also disinfected, or whether they 
are separated ? 

Dr. Frederick Montizambert. — The things are unpacked and put in 
wire caged trunks of the same size as the pieces of luggage. If there are 
not enough things to fill them, the things are taken out of the containers 
and passed into open wire trunks. In case the articles are small in num- 
ber and size, they are put in an open bag, and where — as is the case with 
the worst class of emigrants — ^people have neither trunks nor bags, the 
bundle goes in with its contents opened out. The temperature in the 
inside is about 200 F. Then a vacuum pump is set to work until it 
throws 7}^ pounds of pressure, so that the steam enters the innermost 
recesses where the clothing is. Finally, a pressure from 13 to 14 pounds 
to the square inch is exerted, and the steam enters the innermost meshes 
of the clothing. An electric bell rings at 212, indicating that the tem- 
perature has reached that degree in the interior of the closest trunk. 
The things are held at that temperature for half an hour. If the 212 bell 
rings again, it is an indication that the temperature is getting low, and 
more steam is turned on. After the 212 bell has rung, and the dial has 
passed over the button, in a short space of time another bell rings, and 
we have 115 degrees C. in the inside of the most inaccessible portion of 
the contents of the chamber, kept up for thirty minutes. If necessary, 
and I think it is, we should keep the temperature of the chamber between 
100 and 115 degrees C. for twenty minutes. 

A Member. — What is your observation of steam disinfection at such a 
temperature on the clothing ? 

Dr. Frederick Montizambert. — ^We have no ill effects from steam 
disinfection on the clothing, except a running of some of the dyes of the 



28o , PROCEEDINGS AND DISCUSSIONS, 

inferior articles. All of the dyes of the cheaper clothing run a little. 
The material itself does not seem to be injured, that is, the class of cloth- 
ing subjected to that process. There are certain things, such as boots, 
rubber and fur articles, that cannot be so treated. They are rare among 
the class of emigrants that come to this country. As a rule, we have pro- 
vided for them the bichloride of mercury solution — i-iooo — ^and they are 
thoroughly saturated with it. If what we are taught by bacteriologists is 
to be believed, the danger of the introduction of cholera on the dry sur- 
face of a container or of a boot is infinitesimal. We are taught that the 
cholera germ perishes on a dry surface. The only class of emigrants who 
are at all likely to strip the clothing off the corpse of a cholera patient 
are of the lowest, poorest class of Russian Jews, if it is conceivable even 
that they would do it. 

Any of the better classes of people would surely have their clothing 
laundried and boiled before they brought it out. The danger of the 
introduction of cholera from the inside of a trunk is infinitesimally small. 
The only class of people likely — from their extreme poverty and extreme 
absence of ideas of decency and cleanliness — to bring along clothing with 
them to this country infected with cholera dejecta, are not likely to have 
either boxes, bags, or trunks. 

Dr. F. J. Mayer, of Louisiana. — I would like to correct an impres- 
sion that has been made, to the effect that it is only in Canada that the 
baggage of emigrants is disinfected by steam process. We have done 
that for years in Louisiana. All of the baggage is subjected to steam 
heat at a temperature of i8o dry and 230 moist for an hour, and the con- 
tainers are disinfected by sulphur and the bichloride of mercury solution. 

As to the question propounded to Dr. Montizambert, as to the eflS- 
ciency of heat disinfection for other contagious diseases than cholera, I 
will say that for the past thirteen years it has proved efficacious about 
the port of New Orleans. 

A Member. — What solution of bichloride of mercury do you use t 

Dr. Frederick Montizambert. — One to one thousand. 

Dr. F. J. Mayer. — I think i : 1000 is equally efficacious for the yellow 
fever germ, and unquestionably if it is for that germ it is for the germ of 
diphtheria and the germs of other diseases. 

Dr. J. H. Davison, of California. — I take issue with Dr. Mayer in the 
last statement made. The fact is, the germ of diphtheria, as also other 
germs, especially the spore-producing germs, are not readily killed by the 
bichloride solution of the strength mentioned by the doctor. In the light 
of recent research on this subject, where we depend upon the bichloride 
solution, or any other antiseptic solution, we have got to have a strong 
one, and keep up the temperature a considerable time. Simply brushing 
over the outside of a box or trunk, as in the case of diphtheria, with a 
solution of bichloride of mercury — even 1-800, as the doctor suggests — 
does not destroy the germs in all cases. 

Dr. Henry B. Baker. — There is another consideration in this con- 



PROCEEDINGS AND DISCUSSIONS. 281 

nection, and that is, while brushing over the outside of a trunk with a 
solution of bichloride of mercury, i-iooo — and it is the outside of it 
which is in danger of infecting persons with the sputa of diphtheria or 
consumption — have we any assurance that the specific cause of diphtheria 
attached to that trunk will be reached by the solution? I think not. 
Now, as I have previously remarked, the diseases which we fear in our 
state are consumption and diphtheria, and it is the exterior of the con- 
tainer which is most liable to be contaminated with infectious material. 
It is the old trunk which has stood in the living-room for years ; the old 
hand-bags ; the old-fashioned country boxes ; — ^hundreds of them come to 
our borders. They have been in the family for years, and they go into 
the homes of the people in our state. Perhaps they are used in some 
cases as tables on which to take food and eat their cake from. It is the 
style of material that we in our state are asked to guard against. That is 
the reason why there is an implied criticism in the action of the Michigan 
State Board of Health on the action in the Dominion of Canada. We are 
ready to grant that the measures which have been taken in Canada 
against cholera are in advance of anything that has been done heretofore 
in the northern part of our country ; but in our state the law requires us 
to have a record of other diseases than cholera — those which in years 
past have caused a greater mortality. We would be glad if Canada could 
make another advanced step, and help to protect our people from those 
diseases which have caused a greater death rate than cholera. 

Dr. R. H. Lewis. — In regard to the probable infection of the surface of 
a trunk or box, it seems to me that practically the danger of such a thing 
is slight, for the reason that the child of a family who would be exposed 
to the sputum of diphtheria or consumption, has already been exposed all 
its life to that same contagion. If there was a case of diphtheria, then 
of course extra precautions would be taken to thoroughly disinfect the 
surroundings, but it seems to me there is no necessity, on general princi- 
ples, to fear infection from the surfaces of trunks. The children of the 
family have already been exposed to that contagion before they left home, 
and did not take the disease ; and I hardly think the climate of America 
would bring it out. 

Dr. H. B. Baker. — My friend that has just spoken misapprehends 
the facts. It is not altogether the children of emigrants who have per- 
haps become immune by coming from another country where they have 
more cases of that disease, but it is the children in the families of the 
residents of our state who become infected. I am speaking now from 
actual observation. Last fall an emigrant with his luggage came to a 
place in our state, and the people of that place immediately came down 
with small-pox. Those who came down with the disease were people 
who did not immediately come from foreign countries, but were those 
who had been living in the state of Michigan for a long time. The 
death rate from scarlet-fever in our state is now not one half of what it 
was formerly. 



282 PROCEEDINGS AND DISCUSSIONS, . 

Dr. K T. Lachapelle, of Montreal, Can. — If we want to attain our 
object, we must be practical in every way, and must not exaggerate the 
precautions against the people who are coming from Europe or the other 
side of the ocean. And as there is diphtheria in every province in North 
America as well as tuberculosis, if we are so much afraid that the pre- 
cautions are not sufficient against travellers and emigrants, why should 
they not do the same for us .^ We ought to disinfect on the border of 
each state or province, city or town, or comer of each street. We never 
know when infection is likely to spread. If we take the precautions to 
disinfect the linen of emigrants — to be sure there was disease in the fam- 
ily everything is disinfected — ^we ought to be satisfied in disinfecting the 
outside of trunks, and what is the use of disinfecting any port of entry 
infected through the cars and elsewhere? I think it is better not to 
exaggerate if we want to succeed, for if we do then transportation com- 
panies and the railroads will rebel against us. They will resist. So I 
think it is better not to carry our methods of disinfection too far. 

Dr. C. O. Probst. — It seems unjust to imply any criticism against 
the Canadian system of quarantine. I understand that Dr. Montizam- 
bert only claims by his process immunity against cholera, and the 
Michigan State Board of Health is well satisfied with what is being done in 
Canada as regards cholera. Now it does seem to me that we are asking 
a great deal of the Canadian government to give us protection against 
diphtheria, scarlet-fever, and consumption, when there is scarcely one of 
our quarantine stations in this country which is practicing it. At the 
New York meeting, it was recommended that there should be disinfection 
of the baggage of emigrants, and quite a number of quarantine ports were 
represented. The representatives went home after the meeting and 
resolved to carry it out, but Canada is the only one that has thus far car- 
ried out the recommendations of that meeting, to my knowledge. They 
are to be commended for this, and not blamed in any particular. 

Dr. L. F. Salomon, of New Orleans. — I am always willing to be 
taught if our system of disinfection can be improved. In regard to 
steam disinfection, we cannot put a leather trunk into one of these cylin- 
ders, or a rubber cloak, without impairing it, so we resort to the white- 
washing process with a whitewash brush, using the bichloride of mercury 
solution. It is well enough for a person in the interior of a state, who 
has no experience with the practical work of disinfection by steam at a 
port of arrival, to be hypercritical, but what can we suggest to improve 
our methods of disinfection without destroying the goods of passengers 
who come to our ships with articles of the description mentioned ? 

Dr. H. B. Baker. — The members of the Michigan State Board of 
Health have been dealing for the past fifteen years with the restriction 
of diphtheria, with very satisfactory results. We have in our state sta- 
tistics which enable us to show the results where isolation and disinfec- 
tion have been carried out in an outbreak of diphtheria. An experience 
of many years proves that at least four fifths of the cases of diphtheria 



PROCEEDINGS AND DISCUSSIONS. 283 

are prevented by isolation and disinfection after the first case has oc- 
curred, and not by the method that has been mentioned here, namely, 
the bichloride solution, but another one. The State Board of Health of 
Michigan recommends the exposure of articles in a room to the fumes 
of burning sulphur, and we have actually positive demonstrations of the 
value of this method. We have had hundreds — yes, I might say thou- 
sands — of instances in which diphtheria has been prevented by the disin- 
fection of all articles in rooms by the fumes of burning sulphur. 

A Member. — What quantity of sulphur do you use ? 

Dr. Baker. — We use three pounds of sulphur to each thousand feet 
of space in the room. 

Dr. Probst. — How long is the exposure ? 

Dr. Baker. — Our board recommends an exposure of from twelve to 
twenty-fotur hours. Here is a practical fact, which is verified by prac- 
tice. Take a room, in an ordinary house, ten feet square, and disinfect it 
with three pounds of sulphur, burn it all, close the openings in the room, 
having no opening in the chimney or fireplace, and, notwithstanding that 
precaution, any one who has had experience with this method, in going 
into that room after a few hours, he will find that the strong fumes of 
the sulphur are no longer there. During the first hour a person can 
scarcely see a foot across the room on account of the fumes being so 
dense. After the sulphur has all been burned, the law of diffusion of 
gases comes in, and the strong fumes disappear. 

Dr. William Bailey, of Louisville, Ky. — One word regarding the re- 
marks of Dr. Baker. He confesses that there is an undue prevalence of 
diphtheria, consumption, etc., in Michigan. Many foci already exist for 
the distribution of these diseases among his own people. Now would it 
not be better, by means of disinfection, to protect his own people from 
the dangers already among them ? Would it not be better for him to 
pay attention to the disinfection of his own people, instead of asking the 
authorities of Canada for protection against these diseases ? I maintain 
that by proper disinfection of the places where foci of these diseases 
exist, people are protected, and the danger from the outside is reduced 
to a minimum. 

The President. — My object in asking Dr. Montizambert a question 
concerning the temperature and time of exposure was this : As he knows, 
there are quite a number who have been at this work for many years, 
and practically we have injured a great many pieces of clothing. Our 
habit at my station is to raise the temperature to 230° F., and hold it at 
that point for twenty minutes. We have been taught that this was nec- 
essary in order to kill the germs. Now in view of what was said to us 
by Dr. Sternberg last evening, it strikes me we are doing rather more 
than we need to do in trying to kill these germs. I want to speak of an 
additional fact which is one source of great mortification to me, and that 
is, when the clothing of these people is held for twenty minutes in a tem- 
perature of moist heat of 230°, the shrinking, the discouraged appearance 



284 PROCEEDINGS AND DISCUSSIONS. 

of those articles when they come out, and the remarks made to us by 
their owners, make me feel encouraged by what Dr. Sternberg said last 
night that we needed only a temperature of 140^ F. in order to kill all of 
the non-spore-producing bacteria. I ask Dr. Montizambert and others, 
who, with myself, are doing this very work in putting clothing through 
such a terrible process, whether it would not be wise to let up a little 
and spare the clothing a trifle of the damage which I know we are now 
doing. I feel so greatly encouraged by the remarks of Dr. Sternberg last 
evening, that I ask practical men this question. 

Dr. Montizambert. — It is my observation that the clothes are injured 
but slightly by the process of disinfection by steam. As I have previously 
said, there is a little running of some of the commoner aniline dyes and 
commoner forms of cloth. 

The President. — Would it not be safe to shorten the time in view of 
what was said by Dr. Sternberg? Can we not stop short of twenty 
minutes.^ 

Dr. Montizambert. — I do not think thirty minutes makes any prac- 
tical difference in handling the clothing of emigrants. If we get author- 
ity from those whom we have a right to look upon as our leaders to stop 
the process as soon as the temperature reaches 212° F., I shall be glad 
indeed. As far as instructed, our rule is to hold above 212° for thirty 
minutes. 

EVENING SESSIONS O'CLOCK. 

The Association was called to order at 8 p. m. by the President. 

At this session addresses were delivered by Dr. Sarah Hackett Steven- 
son of Chicago, on '* Municipal Sanitation '' (see page 242) ; by Miss Ada 
Sweet of Chicago, on " Voluntary Health and Public Improvement Socie- 
ties" (see page 176); a paper by Sir Charles Cameron of Dublin, Ire- 
land, on " Importance of Civic Public Hygiene to the State " (see page 
186), which was read by Dr. C. N. Hewitt, in the absence of the author. 

Dr. S. W. Abbott, Secretary of the State Board of Health of Massa- 
chusetts, read a paper entitled "National Registration a Necessity." 
(See page 63.) 

Dr. E. S. Kelly, of Minneapolis, read a paper entitled " Municipal San- 
itation of Minneapolis." (See page 169.) 

Dr. Jesus K Monjaras, of San Luis Potosi, Mex., followed with a paper 
entitled " The Importance of Sanitary Bureaus : Their Economic Organ- 
ization." (See page 69.) 

Dr. Hewitt. — I move that the suggestions contained in the last paper 
with reference to the organization of an international committee for nom- 
enclature of disease be referred to the American Public Health Associa- 
tion, with the request that some action be taken in the matter. He has 
opened up the subject very nicely, and Dr. Abbott's paper is exactly in 
line with it. 

(Seconded.) 



PROCEEDINGS AND DISCUSSIONS, 285 

Dr. John B. Hamilton, of Chicago. — I understand the nomenclature 
of the Royal College of Physicians and Surgeons is now being revised. 
It would seem we ought to have a committee for that purpose, or have 
an American nomenclature out and out. The last revision of nomen- 
clature was in 1880, and the one before that, in 1870. The present 
nomenclature is adhered to pretty closely, and is the nomenclature of 
the Royal College of Physicians and Surgeons, and if there is anything 
to be done, we ought to appoint a committee of our own to cooperate 
with their committee as seems best. 

The President. — Do I understand the motion to include the two 
papers ? 

Dr. Hewitt. — Yes. My motion is that the suggestions in the two 
papers (Dr. Abbott's and Dr. Monjaras's) be referred by this Congress 
to the Executive Committee of the American Public Health Association, 
and a committee appointed for that purpose. 

The President then put the motion, which was carried. 



Friday, October 13, 1893. 

MORNING SESSION— 10 aCLOCK. 

The Association was called to order at 10 a. m. by the first Vice-Presi- 
dent, Dr. Eduardo Lic^aga, of Mexico. 

The first paper read was by Dr. Miquel Marquez, of Chihuahua, Mex., 
entitled "Animal Vaccine — Why it should be Preferred to Human Vac- 
cine." (See page 84). This paper was read by Dr. Lic^aga's son. 

Dr. Jerome Cochran, of Montgomery, Ala., read a paper entitled "An 
Experiment in Disinfection — How an Epidemic of Pneumonia was 
Checked." (See page 21). 

Dr. Charles N. Hewitt, of Red Wing, Minn., read a paper on " The 
Best Way to Restore the Practice of Vaccination to its Proper Place as a 
Preventive of Small-Pox." 

Dr. Benjamin Lee. — Mr. President, if it is in order, I desire to intro- 
duce a resolution in connection with Dr. Hewitt's paper. 

The President. — There is no objection, doctor, and you may proceed. 

Dr. Lee. — I desire, sir, to introduce the following : 

Resolved^ That the International Congress of Pablic Health affirms in the strongest 
possible manner its confidence in the value of vaccination as a preventive of small-pox. 

We have been having an epidemic of small-pox in our state, in which 
recourse was made to the local board in consequence of the publication 
in a German newspaper of articles in opposition to vaccination, and in 
the strongest manner decrying it. It would aid us very much if such a 
resolution could be passed. 

Dr. S. W. Abbott. — I warmly second the resolution. As secretaries 
of state boards of health, we cannot but see the force of it. 



286 PROCEEDINGS AND DISQUSS/ONS. 

The resolution was then put and adopted. 

Dr. E. Lic^aga, of Mexico, then read a paper entitled "A Contribution 
to the Study of Yellow Fever from a MedicoXJeographical and Prophylac- 
tic Point of View in the Mexican Republic." (See page 122). 

An address to the Committee on Yellow-Fever, by Dr. Felix Formento, 
of New Orleans, was read by Dr. Brewer. (See page 120). 

Dr. Manuel Carmona y Valle, of Mexico city, read a paper on " Yellow- 
Fever." (See page 89). 

Dr. Gregorio Mendizabal, of Mexico, read a paper on " La Grippe." 
(See page 224). 

Mr. Clark, of Chicago, extended the Association an invitation to visit 
the Chicago Athletic Association. 

Dr. Roque Macouzer, of Mexico, contributed a paper on " Diphtheria 
in the City of Mexico," which was read by Dr. Gihon in the absence of 
the author. 

Dr. Gihon introduced a resolution by Dr. Monjaras, as follows : 

Resolved^ isi^ That the educational authorities of the various nations represented here 
be requested to devote a longer time than they now do, in their curriculum, to the teach- 
ing of hygiene. 

zd^ That the governments of the countries represented at this congress be urged to 
appoint to sanitary positions and commissions only such persons as may have acquired a 
special education in sanitary studies. 

Referred to the Executive Committee. 

Dr. Francisco Marin, of Puebla, Mex., contributed a paper entitled 
" Notes on Scarlet Fever in the City of Puebla." (See page 215). 

Dr. C. N. Hewitt. — Mr. Henry Lomb, of Rochester, N. Y., so well 
known to the members of the American Public Health Association, has 
again offered two prizes. The first one is of $500 for the production of 
the best treatise upon hygiene and public health available for use among 
pupils in schools and teachers. For the purpose of securing and laying 
out lines required by the Committee in the broadest and most judicious 
manner, he has requested that the Committee communicate with, and 
receive communications from, everyone interested in the matter, as to 
what, in their opinion, should be the foremost subject that should be 
insisted upon with the writers for this prize. He has provided that, in 
case the Committee should find other works or treatises on special 
departments of public health worthy of consideration, a further prize of 
as much as $500 shall be added thereto, this to be under the direction of 
the American Public Health Association whose Executive Committee has 
appointed a committee on this subject. He has drafted a resolution to 
be presented to this Congress, which, with your permission, I will read 
and submit. 

Dr. Hewitt then read the resolution as follows : 

Resolved^ ist, That this congress urge upon the people of the countries here repre> 
sented, the importance of completing our sanitary organization by forming voluntary 
Public Health Associations, to study for themselves the conditions of healthy living in 



PROCEEDINGS AND DISCUSSIONS. 287 

the home and the community, and to a£Eord efficient and persistent support to the work 
of public health officials. 

ift/, That this congress respectfully ask state and local boards of health to assist in all 
proper ways the formation of such organizations. 

Dr. Hewitt moved the adoption of the resolution, which was seconded 
and carried. 

Dr. William Oldright, of Toronto, Can., then read a paper entitled 
" Unrest." (See page 210.) 

On motion, the Association adjourned until 2 p. m. 

AFTERNOON SESSION— 2 O'CLOCK, 

The Association reassembled at 2 p. m., and was called to order by the 
President. 

A paper by Dr. Arthur Renwick, Commissioner from New South Wales 
to the World's Columbian Exposition, on " Sanitation in Great Britain," 
was read by title ; also a paper by Dr. M. Kagami, Japanese Imperial 
Commissioner to the World's Columbian Exposition, entitled " Sanitation 
in Japan." 

Dr. Benjamin Lee, of Philadelphia, read a paper entitled *' How Shall 
Our Lepers be Cared For ?" (See page 246.) 

DISCUSSION. 

Dr. C. N. Hewitt. — I happened to be called upon to read the paper 
of my friend. Dr. Lee. You notice that there are no statistics given of 
this matter, except a brief r^sum^ of the number of lepers which exist in 
the United States. For the last twenty-two years I have kept an accurate 
record of every case of leprosy which appeared in our district. We have 
had leperologists from Norway, who have been sent by the government of 
Norway to see the effect of climate on the disease. I have been cogniz- 
ant of every case reported or discovered by physicians in our state, and 
we have been studying the matter very thoroughly. It has been a matter 
of business with us, and during all this time we have had forty cases in 
all. We have some sixteen now — more than the doctor gave us credit 
for. We have traced the history of every leper that has appeared in 
Minnesota from his birth to his death. We have families in Minnesota 
where there are four generations of them, the fathers lepers, and not a 
case in the descendants. We have not a case in Minnesota which was 
produced in the district or in this country ; every case we have has been 
traced to infection. There is not the first symptom that we have been 
able to discover in Minnesota of the infectiousness of the disease, as 
demonstrated by the actual occurrence of infection. During these times 
these people are not the offensive outcasts they are supposed to be. 
Only a few of the cases take on that form of the disease which is hideous 
in its development. Every one of the lepers in our state knows what the 
character of the danger is, what his duty is in the matter. They live 



288 PROCEEDINGS AND DISCUSSIONS, 

quietly with their families, many of them well-to-do. They are protected 
and properly cared for. If there was the slightest occasion for suspicion 
during the twenty-two years that I have had direct charge of the matter^ 
we had the power by law to segregate these people, but there has been 
no justifiable ground for such segregation. They are diminishing in 
number. 

Dr. Hansen, the discoverer of the leper bacillus, and the greatest 
authority now living upon the subject, is physician to the Bergen Leper 
hospital, established by the Norwegian government for the purpose of seg- 
regating these people from their relations. He found it was the filth, in 
a large measure, in houses which increased the prevalence of the disease, 
and he secured the voluntary isolation of these people by giving them 
better accommodations than they were accustomed to have at home, the 
lepers being mostly of the poor class, and many of them fishermen. 
The disease, under improved sanitary conditions and this method of 
segregation, has gradually diminished in Norway until it is now becom- 
ing manageable. 

While leprosy is conceded technically to be an infectious disease, it is 
vastly less infectious than syphilis or tuberculosis, the ordinary diseases 
of our civilization. When the filth conditions are removed and the suf- 
ferers from leprosy are put in moderate circumstances, they get along 
well. 

Dr. Hewitt then read a letter written by Dr. Hansen to himself. (See 
page 252). 

Dr. Plunkett moved that the paper by Mrs. Coleman Stuckert, of Den- 
ver, Col., entitled " Cooperative Housekeeping as a Conservator of 
Nerve Force," be read by title and referred to the Committee on Publica- 
tion. (See page 116.) 

(Seconded and carried.) 

On motion, the Association adjourned. 



Saturday, October 14, 1893. 
MORNING SESSION^io O'CLOCK, 

The Association was called to order at 10 a. m., by the President. 

The first thing in order was the report of the Executive Committee, 
which was read by the Secretary, containing the names of candidates for 
membership. 

Dr. Benjamin Lee. — I would like to make an explanation with regard 
to the name of Mr. Henry Murphy, of the State Board of Health of Penn- 
sylvania. We are unable to find his name in the list. His name was 
simply put on the registration slip. He paid his five dollars, and if it is 
possible, I would like to have his name included. I therefore move that 
the rule be suspended, and that Mr. Murphy's name be acted upon with 
the others that have been presented. 

(Carried.) 



PROCEEDINGS AND DISCUSSIONS. aSp 

It was then moved that the Secretary be authorized to cast the ballot 
of the Association for the election of those whose names were read, which 
he did, and they were declared duly elected. 

Thb Sbcrktary. — ^With reference to the resolution ofEered by Dr. Wal- 
cott and referred to the Executive Committee, which pertains to a sani- 
tary officer in connection with the national government, the Executive 
Committee have considered this resolution and recommend its adoption 
by the Association. (See page 289.) 

Dr. Jerome Cochran. — I would like to offer an amendment with 
regard to the disposition of the resolution, but not to change it. I move 
that the Secretary of the Association be instructed to have the resolution 
printed in circular form and sent to the members. 

(Seconded.) 

A Member. — I would like to see a change somewhat in the wording of 
the resolution. 

The President. — Any amendment to the resolution itself would send 
it back to the Executive Committee, which would mean the abandonment 
of it for this meeting. 

A Member. — I hardly think it is fair, considering the work that is now 
being done, and done so systematically and conscientiously, with our 
present health officers. I think this Association should hold up its hands 
with the present sanitary officers and help them, and not cast any such 
reflections upon them. 

Dr. Albert L. Gihon. — Dr. Walcott contemplates having a national 
board of health with a wider scope to attend to other matters. The par- 
ticular functions of the present sanitary authorities are limited by law. 
The resolution looks beyond that, and contemplates the active coopera- 
tion of all state boards of health. 

A Member. — If I understand the thing correctly, the idea is to have a 
medical officer, or head of the health department at Washington, who will 
be on a par with cabinet officers. I want to say this : We all know that 
cabinet officers are political appointees, and are constantly changing with 
each administration. There may happen to be a political doctor, and he 
may be a homeopath. You cannot take it away from the present ser- 
vice : he either must be an officer in the army, the navy, or the Marine 
hospital service. I claim that this Association ought to help to build up 
what we have, and not build up something we have not. 

Dr. Benjamin Lee asked that the resolution be re-read by the Secretaiy, 
which was done, and the resolution was adopted. 

Dr. Jerome Cochran. — I now renew my motion that the Secretary be 
instructed to print the resolution in circular form and send it to all the 
members of the Association and to members of Congress. 

(Seconded and carried.) 

The Secretary. — ^The Executive Committee recommend the adoption 
of the following resolution, offered by Dr. Monjaras, as follows : 



290 PROCEEDINGS AND DISCUSSIONS. 

Res^hfcd^ ist. That the educational aathorities of the various nations represented here 
be requested to devote a longer time than they now do, in their curriculum, to the teach- 
ing of hygiene. 

jk/, That the governments of the countries represented at this congress be urged to 
appoint to sanitary positions and commissions only such persons as may have acquired 
a special education in sanitary studies. 

Dr. Gihon moved its adoption. 

(Carried.) 

Dr. Gihon. — I would ask the Secretary whether it is the desire to 
have this resolution printed and similarly distributed. I do not think we 
ought to wait for the publication of our Transactions, and I therefore 
move that the resolution be printed in circular form and distributed as 
the Secretary thinks best, among the different schools, the governmental 
authorities, and so on. 

(Seconded.) 

Dr. Sharp. — May I say a word on this subject? I speak from the 
standpoint of a medical man. I am acquainted with the announcements 
of all medical colleges in the country which have made a study of the sub- 
ject, and I believe the medical colleges are doing all they can in this 
direction. 

(Motion carried.) 

The Secretary. — Regarding the proposition made by Dr. Monjaras 
concerning statistical reports and nomenclature, the Executive Committee 
have considered the same, and recommend instead the following : 

Resotvid^ That a special committee on ^ Nomenclature of Diseases and Forms o£ Statis- 
tics" be appointed, and that the special committee on "Forms of Statistics" be dis- 
continued. 

It was moved that the report of the Committee be adopted. 

(Seconded.) 

Dr. Gihon. — ^Are we not travelling a little out of our line in having a 
committee on the nomenclature of diseases ? There is now a committee. 
It seems to me that this matter would come before another body than 
ours. As members of the American Public Health Association, I should 
like to know what we have to do with nosology? 

Dr. Plunkett. — ^The gentleman has asked a pertinent question. If 
he will for a moment think, it will occur to him that the mortality statis- 
tics are the basis of our work. These statistics are compiled how ? Upon 
the nomenclature of diseases, and we may adopt one form or another. 
There are a great many irregularities. This Association, feeling the 
importance of this whole question, as practical sanitarians we can draft a 
form of nomenclature which can be adopted. That is my notion of it. 

Dr. Cochran. — I agree with Dr. Gihon that this matter belongs more 
to physicians than to sanitarians, and any system of nomenclature that 
is gotten up should apply not only to our own country, but to all other 
civilized countries, so that we may have uniformity. There was a move- 
ment in that direction by the Royal College of Physicians, which resulted 



PROCEEDINGS^ AND DISCUSSIONS, 29I 

in a nomenclature which was adopted. It is still in force, but needs 
revision. This revision should come from the medical men of the civi- 
lized world, and not from this Association. 

Dr. John H. Rauch. — Several years ago we adopted the nomencla- 
ture of the Royal College of Physicians, England. It is of the utmost im- 
portance that there shall be uniformity with regard to the nomenclature 
of diseases, both for doctors and sanitarians. I am in favor of a resolu- 
tion of this kind, as it is in the right direction. We might get the coop- 
eration of the American Medical Association, and we can communicate 
with those who have it in charge in England. 

Dr. Lee. — ^Any one who has taken the trouble to look over the reports 
of registration in large cities or small cities — I speak now of Philadelphia, 
because I am familiar with them — will appreciate the necessity for some 
definite authority of statement as to the nomenclatiu-e of diseases, in 
order that we may obtain correct and reliable statistics. The statistics 
of Philadelphia to a great extent are a mere hodge-podge, from the fact 
that ignorant men report diseases under a general name, and often report 
them under fictitious names. The adoption by this Association of a defi- 
nite nomenclature, I am certain, would go far towards establishing cor- 
rect statistics in our cities. 

Dr. Gihon. — I desire to move, as an amendment to the resolution, 
that the specific object of this nomenclature is to establish a uniform sys- 
tem of sanitary statistics and reports. 

The amendment was accepted, and the recommendation of the com- 
mittee adopted as amended. 

Dr. Sharp. — I move that the committee be instructed to cooperate 
with the American Medical Association, if a similar committee is ap- 
pointed from that body. 

(Carried.) 

The next thing in order was the report of the Advisory Council, which 
was read by the Secretary, as follows : 

MEETING OF THE ADVISORY COUNCIL. 

October 13, 1893, 9 : 30 a. m. 
Dr. Probst was elected Secretary. 
Dr. Gihon moved to proceed to elect officers. 
Seconded by Dr. Baker, and carried. 
Drs. Hewitt and Hunt were appointed tellers. 
Dr. Watson moved an informal ballot for President be taken. 
(Carried.) 

Ballot — Dr. Lachapelle 14, Dr. McCormack 6, Dr. Plunket 3, Dr. 
Lindsley z. 

Dr. Groodwin moved a formal ballot be taken. 

(Carried.) 

Drs. Lachapelle and McCormack were nominated. 



292 PROCEEDINGS AND DISCUSSIONS. 

Ballot — Dr. Lachapelle 23, Dr. McCormack 8, Dr. Lic^aga 4. 

Voted, to make the election of Lachapelle unanimous. 

Drs. Carmona and McCormack were nominated for first Vice-President. 

Ballot — Dr. Carmona 24, Dr. McCormack 11, Dr. Mendizabal i. 

Voted, to make the election of Dr. Carmona unanimous. 

Drs. McCormack and Cantwell were nominated for second Vice-Presi- 
dent. 

Ballot — Dr. McCormack 29, Dr. Cantwell 7, Dr. Probst i. 

Made unanimous. 

Dr. Thompson moved that the Secretary cast a ballot for Dr. Holton 
for Treasurer. 

Carried, and Dr. Holton was declared elected. 

Drs. Reeve, Licdaga, and Thompson were nominated for members of 
the Executive Committee for two years. 

Dr. Hewitt moved that the Secretary cast a ballot. 

Carried, and these three were declared elected. 

Dr. Lachapelle invited the Association to Montreal, Dr. Lindsley to 
Chattanooga, Dr. Arwine to Indianapolis, Dr. Thompson to Louisville, 
Dr. Hewitt to Minneapolis, in 1895. 

The invitation to Montreal was unanimously accepted. 

Adjourned. 

C. O. Probst, Secretary. 

On motion, the report was adopted. 

Dr. Lee moved that the Secretary cast the ballot of the Association for 
the election of the officers named. 

(Carried.) 

The Secretary then did so, and the President declared them duly 
elected. 

Dr. Montizambert. — Dr. Lachapelle, on receipt of a telegram, was 
obliged to reach his home last evening, but he requested me, in his be- 
half, to convey to the Association for him, in case he was elected Presi- 
dent, an expression of his warmest appreciation for the high honor con- 
ferred upon him, and to express to you his earnest desire that he may be 
enabled, as far as in him lies, during his term of office, to safe guard the 
interests of the Association, and in so doing he hopes and confidently 
trusts in receiving your cordial cooperation and support. (Applause.) 

Dr. Ranch offered a resolution to suspend immigration during the 
prevalence of cholera, to prevent its introduction into this country, which, 
after some discussion participated in by Drs. Cochran, Gihon, Lee, and 
the President, was, on motion of Dr. Sharp, tabled. • 

The President then announced the special committees for the ensuing 
year. 

Dr. Gihon moved that the Committee on Yellow-Fever be changed so 
as to read, ^ International Committee on the Prevention of the Spread of 
Yellow-Fever." 

(Seconded and carried.) 



PROCEEDINGS AND DISCUSSIONS, 293 

Dr. Gihon. — There has been some little delay in the matter of reports 
of these committees in the past, and I therefore move that the Secretary 
be authorized to send notices to the chairmen of these committees, with 
a list of the members on them, as soon as he possibly can, with the state- 
ment that the Association expects a report from each one of these com- 
mittees at the next meeting, and urge them to communicate with the 
several members of the committee without delay, not to put the thing off 
until the last moment. The chairman of each committee should receive 
an annoimcement as soon as possible to this effect, so that he can ad- 
dress the constituent members, informing them that the Association 
expects a report. 

(Seconded and carried.) 

Dr. Cochran. — May I make an inquiry? The efficiency of these 
committees depends upon the chairmen. Suppose a chairman fails to 
act, what is to be done? I take it for granted that the next member 
whose name is mentioned on the committee is to act. I would like to 
hear from the President on that point. 

The President. — I can only say that this is a matter before the Asso- 
ciation, and open to any suggestions that the members may see fit to 
make. 

Dr. Cochran. — I make a motion to this eflFect, which I do with con- 
sideration, that the Secretary address a letter of inquiry to the nominal 
chairman of each committee, asking him whether he will take hold of the 
matter and endeavor to work it up properly, and request from him an 
immediate reply. In case the nominal chairman fails to give a satisfac- 
tory reply, the Secretary shall notify the second name on the list to act 
as chairman. 

(Seconded and carried.) 

Dr. Gihon then read the following resolution of thanks, and moved its 
adoption, which was imanimously adopted : 

Resdvedt That the thanks of the American Public Health Association be extended to 
Hon. Charles C. Bonney, President of the World's Congress Auxiliary of the World's 
Columbian Exposition; to the chairman and members of the Local Committee of 
Arrangements; to Dr. Sarah H. Brayton, chairman of the Woman's Committee; 
to Dr. Sarah Hackett Stevenson, President of the Woman's Club; to Mrs. Charles 
Henrotin, Vice-President of the Woman's Branch of the World's Congress Aux- 
iliary; to the sanitary commissioners of Chicago; to the collector of the port; to 
the commissioner of health ; to Messrs. P. D. Armour & Co. ; to the Athletic Club ; 
to Mr. W. S. McHarg, Mr. Wells, Mr. Hazen, and others, for invitations and courtesies 
extended; to Dr. Frank W. Brewer, chief of the Bureau of Sanitation and Hygiene of 
the World's Columbian Exposition, whose time, patience, and amiability have been 
severely tried in our behalf during this busy time, and who has ever proven himself to 
be uniformly courteous and kind. 

CLOSING REMARKS BY THE PRESIDENT. 

The President. — I think we may properly congratulate ourselves upon 
the good attendance and strict attention which has been paid to the many 



294 PROCEEDINGS AND DISCUSSIONS. 

remarkably interesting papers and discussions with which we have been 
favored at this meeting ; and personally I desire to thank you for the 
courtesy and support which you have given me in discharging my duties 
as presiding officer at this meeting. I shall carry the remembrance of 
this meeting home with pride and a good degree of satisfaction. (Ap- 
plause.) 

REMARKS BY DR. BREWER. 

Dr. Brewer. — Mr, President and Gentlemen : I must confess that on 
Tuesday last I felt somewhat embarrassed when the Congress was ready 
to begin its work and we had no programmes ready for you. This was 
entirely due to the fact that the printers celebrated Chicago Day at the 
World's Fair. But I feel more embarrassed on the present occasion for 
the cordial vote of thanks Dr. Gihon has proposed and you so kindly 
endorsed. I assure you that the little I have been able to do during the 
last three months and the present week has been more than amply 
repaid by the kindness and courtesy I have received at your hands. If 
you are satisfied with me and the manner in which I have endeavored 
to carry out the duties of organizing Secretary, I can assure you I am 
more than repaid. I have endeavored to do my duty on this occasion. 
No one more than myself could recognize the shortcomings that were so 
apparent. The fact is, we were actually ''snowed under" by the prepa- 
rations for Chicago Day and the excitement which had existed. I thank 
you very much for your kindness. 

On motion, the Association adjourned to meet in Montreal, Canada^ 
September 25-28, 1894. 



ANNUAL REPORT OF THE TREASURER OF THE 
AMERICAN PUBLIC HEALTH ASSOCIATION. 

RECEIPTS. 

Amount received of late treasurer, Dr. J. B. Linds- 

ley, in Mexico, $1,019.38 

^Received from J. B. Lindsley in final settlement 

of his account in full as late treasurer, . • 3)524-52 

Transactions sold, Z4B.43 

Membership dues, 1,218.15 

Total, $Sf9^o.4& 

DISBUKSSMENTS. 

Jan. 20, 1. A. Watson, expenses as per bill, order 

No. I, $651.45 

'Feb. 9, Chas. Smart, balance due him on index, 

order No. 2, 300.00 

Apr. 3, Insurance, order No. 3, . . . • 25.00 

Apr. 3, Freight on books, order No. 3, . • • ^S'^9 

Apr. 15, Geo. C. Averill, services auditing treas- 
urer's account, order No. 4, • . . . 25.00 

May 9, Republican Press Association, order No. 5, 880.80 

July 8, J. B. Lindsley, expenses as per bill, order 

No. 6, 363'3S 

July I z. Republican Press Association, order No. 7 916.63 

Sept. 20, Henry D. Holton, treasurer; money paid 

as per bill, order No. 8, . • • • 152.09 

Sept 20, 1. A. Watson, expenses as per bill, order 

No. 9, 356.60 

Sept. 26, Cash on hand, 2,154.37 

Total, $599x0.48 

Henry D. Holton, Treasurer, 

1 This includes index fund of I793.98. 

•This is amount paid from index fund, $yx), leaving a balance index fund of ^93.981 
which is included in cash on hand. 



296 PROCEEDINGS AND DISCUSSIONS. 

Chicago^ 111., Oct. ii, 1893. 
GsKTLEMSN : YouT Committee to whom was assigned the duty of au- 
diting the books and accounts of the treasurer, reports that it has performed 
that duty and has found the same correct. 

Respectfully submitted, 

J. N. McCORMACK, 

Domingo OrvaJ^anos, 
William Bailey, 

Auditing Committee. 



REPORT ON NECROLOGY. 

Dr. Edward Houghton Janes, son of Captain Ebenezer and Lucretia 
(Smith) Janes, born in Northfield, Mass., October 3, 1820, died March 12, 
1893, in New York city. He received his early education in the public 
schools of his native town, and afterward studied at the Delaware Literary 
Institute, of Franklin, N. Y., from which he was graduated at the age of 
eighteen. After teaching a few years, he commenced the study of med- 
icine with Dr. Joseph Hedges, of Hope, N. J., and received the d^ree 
of M. D. from Berkshire Medical College, Mass., in 1847. ^^ settled in 
New York city in 1850. In 1862 he was appointed on the sanitary com- 
mbsion of that city ; in 1864, under the auspices of the Citizens' Asso- 
ciation, he, with others, made an inspection of the sanitary condition of 
New York city, which served to inaugurate the present system of health 
government of that city, and resulted in the establishment of the Metro- 
politan Board of Health, with which he was connected until his death. 
He was assistant sanitary superintendent for twenty years, and for ten 
years had the supervision of the hospital for contagious diseases. He 
occupied the chair of hygiene in the Woman's Medical College of the 
New York Dispensary for seventeen years, and for three years he was 
recording secretary of the New York Academy of Medicine. 

Dr. Janes was one of the originators of the American Public Health 
Association, and was its recording secretary from 1877 to 1880. He was 
the author of numerous papers on medical and sanitary subjects, and was 
a member of the Medical Society of the County of New York, Physicians' 
Mutual Aid Association, life member of the New York Historical Society, 
honorary member of the New Jersey Historical Society, member of the 
board of directors of the Oratorio Society of New York, and of the board 
of managers of the New York Association for Improving the Condition 
of the Poor. Dr. Janes served as a volunteer surgeon in the Federal 
army, during the War of the Rebellion. 

Married, October 14, i860, Jane Mills Yates. Their children are 
Martha Ridgway, widow of John McKee Elsmore ; Edward Foster Janes ; 
and Elisha Harris Janes. 

Dr. Elijah Utley Jones was bom May 2, 1826, in Augusta, Me., and 
died November 25, 1893, in Taunton, Mass. In early life Dr. Jones 
struggled with great energy to secure an education, which he accomplished 
at Waterville, Me., Bates College. He taught school for some years, — at 
Uzbridge in 1845 » ^ Slatersville, R. I., in 1846, and in East Douglas, 



298 PROCEEDINGS AND DISCUSSIONS, 

Mass., in 1847, where he remained a year as principal of the academy. 
He taught in North Brookfield in 1848, and then, on account of failing 
health, took a life insurance agency in Dartmouth. He afterwards re- 
turned to his home in Augusta. He studied medicine under the direction 
of Dr. William F. Jackson, of Gardiner, Me. During the winter of i85i-'s2 
he acted as reporter in the Maine state senate for the Augusta Age, With 
the money thus earned he paid for two full courses of lectures at the 
Maine Medical School. In 1853 he went to Concord, N. H., as assistant 
to Dr. Alpheus Morrill, and soon after settled in Dover, N. H. In Feb- 
ruary, 1854, he went to Philadelphia, where he fully graduated at the 
Homoeopathic Medical College of Pennsylvania. On the first of Septem- 
ber, 1854, he moved to Taunton, Mass. 

Aside from a devoted enthusiasm to homoeopathy and its institutions, he 
took a special interest in sanitary science and public health. He was a 
member of the American Public Health Association, and took an active 
interest in its affairs. He made valuable investigation in ozone and cli- 
matic influences on disease. He edited with abUity several volumes of the 
State Homceopathic Society's publications. He was an influential mem- 
ber of his church, the Broadway Congregational, and was first vice-president 
of the Congregational Club. He was also deeply interested in educational 
matters, serving on school committees, etc., and was treasurer of the Old 
Colony Historical Society. His monograph in the first volume on the 
<< Early History of Homceopathy in Massachusetts " is especially valuable. 
He was a constant contributor to the magazines and periodicals in his 
department of knowledge, and was for two years assistant editor of the 
New England Ganette of Boston. 

In 1854 he married Mrs. Sarah Crofoot, daughter of Theodore Stone, 
of East Douglas, who died some four years ago. He had no children, but 
an adopted daughter, Mrs. E. P. Washburn, of Taunton, survives him. 

Dr. Thomas Fanning Wood, of Wilmington, N. C, where he died August 
22, 1892, was bom February 23, 1841, at Nantucket, Mass. He received 
a common school education, attended lectures at the Viiginia Medical 
College, Richmond, and received an honorary degree from the University 
of Maryland in 1868. He was assistant surgeon in the Confederate states 
army, 1863-65, physician to Wilmington Small-pox Hospital, z865-'66. 

At the Fayetteville meeting of the Medical Society of the State of North 
Carolina a committee was appointed to memorialize the legislature for the 
establishment of a state board of health. The result of this action was 
the enactment of a law making the state society the board of health. At 
the next meeting of the society, in 1877, a committee was appointed who 
should perform the arduous duties thus imposed upon the society, and Dr. 
Wood was made the secretary and treasurer. Uninterruptedly, from that 
date to the time of his death, Dr. Wood has held the office of secretary 
and treasurer of the board of health, making its success the chief ambition 
of his life, and giving to the work his untiring devotion and labor. 



PROVRSdHINGS AND DISCUSSIONS, 299 

At the time of the passage of the act cresting the board of health, the 
amount of $100 per year was appropriated for the use c^ the board. Until 
the recent act of 1885, which put the board on a better financial basis, the 
state appropriation was much too little to meet the actual expenses for 
stationery and postage incident to the necessary instruction of the people 
in the methods of sanitation, and in exciting in the state profession an 
interest in the work, but he had the work at heart and it must not fail ; 
so when the appropriation was exhausted he drew with an unstinting hand 
upon his own small store, suffering personal privations that this public 
work might go on to success. 

Great was his satisfaction when the legislature of 1885 created the board 
of health as it exists to^iay, enabling it to do better service. Only those 
who were with him, and to whom he would open his mind on the subject, 
could know the deep anxiety with which he awaited the action of the leg- 
islature, or the true pleasure that its final action gave him. As soon as 
the word reached him that his bill had become a law, he engaged the 
services of an assistant, and proceeded to have county boards of health 
organized, and to establish a voluntary s]^tem of mortuary reports from the 
larger towns of the state. He worked assiduously during that year, and 
when for the treatment of his fatal malady it became necessary for him to 
keep his bed twenty months^ during those anxious days his interest did not 
fiag, but his eye was ever on the watch for rocks and breakers, while his 
hand still held the wheel that directed the ship in its progress. 

Dr. Wood was a member of the New Hanover County Medical Asso- 
ciation, and was its president in 1875 ; North Carolina State Medical 
Society; the Board of Medical Examiners, secretary from 1867 to 1872 ; 
American Medical Association ; American Public Health Association since 
1878 ; Historical and Scientific Society of Wilmington, and chairman of 
its botanical section. He was connected with the North Carolina Medical 
ydumalirom its beginning in 1878, and for a time was its sole editor. 
He was the author of a paper on the *^ Non-Identity of Variola and 
Vaccinia," " Vaccino-Sjrphilis," " Sources of Vaccinia," and various other 
papers. 

Dr. Vickers Thomas Atkinson, son of Stephen and Tamer (Peart) 
Atkinson, was bom August 10, 1852, at Nelson, Ont. ; died at Chicago, 
lU., September 24, 1891, of Bright's disease. Dr. Atkinson was graduated 
in veterinary medicine at Toronto about the year 1875, and for fifteen 
years prior to his death had been a resident of Milwaukee, Wis. In 1885 
he was elected to the common council, and served successively until 1888, 
in which year he was appointed state veterinarian, and lectured on veter- 
inary surgery at the Madison University, for a number of years. He was 
also president of the Wisconsin Society of Veterinary Graduates, and was 
a contributor to the reports of the bureau of animal industry. He 
became a member of the American Public Health Association in z888. 

At the time of his death. Dr. Atkinson was chief inspector at Chicago, 



300 PROCEEDINGS AND DISCUSSIONS. 

of the bureau of animal industry of the department of agriculture. He 
was a member of the Masonic fraternity. 

Married, December 15, 1875, Francis A. Meadows, who survives him, 
together with three children, Fannie, Percy, and Annie. 

Dr. Joseph W. Redden, son of William O. and Margaret Redden, grand- 
son of Stephen Redden, was born August 30, 1834, in Bridgeville, Del. 
He was educated in the common schools of Delaware, at the academy in 
Georgetown, Del., Delaware College, Newark, and at Dickenson College, 
Carlisle, Pa. He commenced the study of medicine in 1854, at George- 
town, Del., his preceptors being Wm. Marshall, M. D., of Georgetown, 
and Prof. Goss of Philadelphia ; attended two courses of lectures at Jeff- 
erson Medical College, and was graduated in the spring of 1857. He also 
took a post-graduate course of lectures in New York and another in Eu- 
rope. In September, 1857, Dr. Redden commenced the practice of medi- 
cine in Wapello, 111., and after one year in that place, he was located one 
year at Nashville, 111., at Metropolis, 111., one year, at Shawneetown, 111., 
nineteen years, and fourteen years at Topeka, Kansas, where he died, 
August 5, 1893. Dr. Redden was a member of Clinton, Massac, and 
Gallatin county, 111., medical societies. State Medical Society of Illinois, 
Shawnee county, Kansas, and Eastern Kansas medical societies, Kansas 
State Medical Society, American Medical Association, American Public 
Health Association, and of the Kansas State Board of Health, of which 
he was secretary from its organization in April, 1885, to July, 1891, when 
ill health compelled him to resign. 

Dr. Redden was surgeon of the military camp of recruits in 1862 and 
1863, located in Gallatin county, 111., where a brigade was usually stationed. 
He was mayor of Shawneetown, 111., during his residence there, and was 
also an elder of the Presbyterian church of that place and of Topeka, 
Kansas. For twenty years Dr. Redden was specially active in Southern 
Illinois and Kansas in Sunday-school work and in mission work, and left 
funds for the erection of a mission chapel, as an outgrowth of Redden 
Mission Sunday-school, Topeka, Kansas. Dr. Redden wrote and pub- 
lished several papers on the diseases of children, and also on epidemics. 
He was an Odd Fellow. 

Married, June 4, 1861, at Shawneetown, 111., Miss Emma L. Jones, 
who survives him. Their children are Miriam, wife of C. B. Smith; Ruth, 
wife of A. Ln Murphy ; and Lee Redden. 



CONSTITUTION 

OP THB 

AMERICAN PUBLIC HEALTH ASSOCIATION. 



TITLE. 

I. This Association shall be called ^^ The American Public Health 
Association.'* 

OBJECTS. 

II. The objects of this Association shall be the advancement of sani- 
tary science, and the promotion of organizations and measures for the 
practical application of public hygiene. 

MEMBERS. 

m. The members of this Association shall be known as Active and 
Associate. The Executive Committee shall determine for which class a 
candidate shall be proposed. The Active members shall constitute the 
permanent body of the Association, subject to the provisions of the con- 
stitution as to continuance in membership. They shall be elected with 
special reference to their acknowledged interest in or devotion to sani- 
tary studies and allied science, and to the practical application of the 
same. The Associate members shall be elected with special reference 
to their general interest only in sanitary science, and shall have all the 
privileges and publications of the Association, but shall not be entitled 
to vote. 

Delegates fron national, state, provincial, and municipal boards of 
health, organized sanitary associations, and the army, navy, and marine 
hospital service, shall be entitled to be enrolled as active members upon 
presentation of their credentials to the Executive Committee. Members, 
not delegates from such bodies, shall be elected as follows : 

Each candidate for admission shall first be proposed to the Executive 
Committee, in writing (which may be done at any time), with a state- 
ment of the business or profession and special qualifications of the per- 
son so proposed. On recommendation of a majority of the committee, 
and on receiving a vote of two thirds of the members present at the reg- 
ular meeting, the candidate shall be declared duly elected a member of 
the Association. The annual fee of membership in either class shall be 
five dollars. 



302 CONSTITUTION, 



OFFICERS* 



IV. The officers shall be a President, a First and Second Vice-Presi- 
dent, a Secretary, and a Treasurer. 

All the officers shall be elected by ballot, annually, except the Secre- 
tary, who shall be elected for a term of three years. 



PRESIDING OFFICER. 

V. The President, or in his absence one of the Vice-Presidents, or 
in their absence a chairman ^re? tempore^ shall preside at all meeting^ 
of the Association. He shall preserve order, and shall decide all ques- 
tions of order, subject to appeal to the Association. He shall also 
appoint all committees authorized by the Association, unless otherwise 
specially ordered. 

SECRETARY. 

VI. The Secretary shall have charge of the correspondence and rec- 
ords of the Association ; and he shall also perform the duties of Libra- 
rian. He, together with the presiding officer, shall certify all acts of the 
Association. He shall, under the direction of the Executive Committee, 
give due notice of the time and place of all meetings of the Association , 
and attend the same. He shall keep fair and accurate records of all the 
proceedings and orders of the Association; and shall give notice to the 
several officers, and to the Executive and other committees, of all votes, 
orders, resolves, and proceedings of the Association, afiecting them or 
appertaining to their respective duties. 

TREASURER. 

VII. The Treasurer shall collect and take charge of the funds and 
securities of the Association. Out of these funds he shall pay such sums 
only as may be ordered by the Association, or by the Executive Com- 
mittee. He shall keep a true account of his receipts and payments, 
and at each annual meeting render the same to the Association, when 
a committee shall be appointed to audit his accounts. If, from the 
annual report of the Treasurer, there shall appear to be a balance against 
the treasury, no appropriation of money shall be made for any object but 
the necessary current expenses of the Association, until such balance 
shall be paid. 

STANDING COBCMITTEBS. 

VIII. There shall be the following standing committees: (i) The 
Executive Committee, (2) the Advisory Council, (3) the Committee on 
Publication. 



CONSTITUTION. 303 



EXBCUTIVB COMMITTEE. 



IX. The Executive Committee shall consist (i) of the President, First 
Vice-President, Second Vice-President, Secretary, and Treasurer ; (2) of 
six active members, of whom three shall be elected annually by ballot, 
to serve two years, and who shall be ineligible to reflection for a second 
successive term ; and (3) of the ex-Presidents of the Association. 

It shall be the duty of the Executive Committee to consider and rec- 
ommend plans for promoting the objects of the Association, to authorize 
the disbursement and expenditure of unappropriated moneys in the 
treasury for the payment of current expenses ; to consider all applica- 
tions for membership, and, at the regular meetings, report the names of 
such candidates as a majority shall approve ; and, generally, to super- 
intend the interests of the Association and execute all such duties as 
may, from time to time, be committed to them by the Association. At 
least one month preceding the annual meeting of the Association, the 
Executive Committee shall cause to be issued to members a notice of 
such meeting, and they are authorized to publish the same in medical, 
scientific, and other periodicals, but without expense to the Association ; 
and such notice shall contain the order of business to be followed at said 
meeting, and, briefly, the subjects to be presented and the special points 
of discussion. 

ADVISORY COUNCIL. 

X. The Advisory Council shall consist of one member from each 
state, territory, and district, the army, navy, and marine hospital ser- 
vice, the Dominion of Canada, and each of the Provinces, the Republic 
of Mexico and each of the Mexican states, who shall be appointed by 
the President on the last day of each session, and who, besides acting as 
nominating committee of officers for the ensuing year, to be announced 
at such time as the Executive Committee may appoint, shall consider 
such questions and make such recommendations to the Association as 
shall best secure the objects of the Association. They shall at their first 
meeting elect from their own number a Secretary, whose record of their 
proceedings shall be made part of the records of the Association. 



COMMITTEE ON PUBLICATION. 

XI. The Committee on Publication shall consist of the Secretary and 
two active members, selected by the Executive Committee, who shall 
contract for, arrange, and publish, under authority of the Executive Com- 
mittee, the proceedings of the Association, including such papers as have 
been examined and approved by the Executive Committee, or which 
have been submitted to them by the latter for their discretionary action. 



304 CONSTITUTION. 



REPORTS ANP PAPERS. 

XII. All committees, and all members preparing scientific reports of 
papers to be laid before the Association at its annual meetings, must 
give, in writing, the title of such reports or papers, the time to be occu- 
pied in reading them, and an abstract of their contents, to the Executive 
Committee, at least one week preceding the date of such meeting, to 
secure their announcement in the order of business. 

MEETINGS. 

XIII. The time and place of each annual meeting shall be fixed at the 
preceding annual meeting, but may be changed by the Executive Com- 
mittee for reasons that shall be specified in the announcement of the 
meeting. Special meetings may be called, at any time or place, by con- 
currence of two thirds of the Executive Committee. There shall be no 
election of officers, or change of By-Laws, or appropriation of money to 
exceed the amount at that time in the treasury, at such special meeting, 
except by a vote of a majority of all the members of the Association. 
Whenever a special meeting is to be held, at least one month's notice 
shall, if possible, be given by circular to all the members, together with 
the order of business. 

QUORUM. 

XIV. At the annual meeting nine members shall constitute a quorum 
for the election of officers, a change of the constitution, the election of 
members, and the appropriation of moneys. 

ORDER OF BUSINESS. 

XV. The order of business at all meetings of the Association shall be 
fixed by the Executive Committee, and such order must be completed 
before any other business is introduced, except such order of business is 
suspended by a vote of four fifths present. 

ALTERATION OF CONSTITUTION. 

XVI. No alteration in the constitution of the Association shall be 
made, except at an annual meeting, or unless such alteration shall have 
been proposed at a previous meeting, and entered on the minutes with 
the name of the member proposing the same, and shall be adopted by a 
vote of two thirds of the members present. 



BY-LAWS OF THE EXECUTIVE COMMITTEE. 



QTJORUM. 



1. Five members shall constitute a quorum for the transaction of such 
business as may come before the committee. 

MEMBERS RESTRICTED. 

2. No elective member of the Executive Committee shall be at the 
same time a member of the Advisory Council, if there is another mem- 
ber of the Association from his state or service. 

PARLIAMENTARY USAGE. 

3. Cushing's Law and Practice of Legislative Assemblies shall be the 
guide of parliamentary practice until otherwise ordered. 

PAPERS. 

4. All papers presented to the Association must be either printed, type- 
written, or in plain handwriting, and be in the hands of the Secretary at 
least twenty days prior to the annual meeting, to insure their critical 
examination as to their fulfilling the requirements of the Association. 

5. If any paper is too late for critical examination, said paper may be 
so far passed upon by the Executive Committee as to allow its reading, 
but such paper shall be subject to publication or non-publication, as the 
Executive Committee deem expedient. 

6. All papers accepted by the Association, whether read in full, by 
abstract, by title, or filed, shall be delivered to the Secretary as soon as 
thus disposed of, as the exclusive property of the Association. Any 
paper presented to this Association and accepted by it, shall be refused 
publication in the Transactions of the Association, if it be published, in 
whole or in part, by permission or assent of its author, in any manner 
prior to the publication of the volume of Transactions, unless written 
consent is obtained from the Publication Committee. 

7. Day papers shall be limited to twenty minutes, and evening papers 
to thirty minutes, each. 



306 BV-LAIFS. 



DISCUSSION OF PAPERS. 

8. After the leading papers on each subject, as indicated by the Execu- 
tive Committee, have been read, discussion shall follow, and be confined 
strictly to the subject of these papers; and each speaker shall be limited 
to ten minutes, and shall not speak a second time until after every other 
member who desires to be heard, and then only for five minutes, except 
by unanimous consent. 

9. The Chair shall notify gentlemen who desire to speak to send up 
their names, and they shall be called on in the order sent up ; and he 
may, at his discretion, limit the time of speaking to five instead of ten 
minutes, if in his judgment it may become necessary to do so in order to 
allow each one on the list an opportunity to be heard. 

PUBLICATION COMMITTEE. 

10. The Committee on Publication, charged with the duties of select- 
ing and printing the papers and Transactions of the Association, shall 
consist of three active members of the Association, and of whom one 
shall be the Secretary, appointed by the Executive Committee during 
the session of the Association, and selected with reference to their facil- 
ities of meeting. 

1 1 . All papers read by title, and others not definitely passed upon by 
the Executive Committee, shall be referred to the Publication Committee 
for critical examination ; and said committee is authorized to reject such 
papers as in its judgment are not worthy of publication, and to omit 
such others as cannot be included within the limits of the annual volume. 

12. The Publication Committee shall procure a copyright on the 
Transactions in the name of the Association, and the committee shall 
have full charge of the publication of the Transactions. 

APPUCATION FOR MEMBERSHIP. 

13. All applications for membership must be made upon the applica- 
tion blank of the Association. 

14. Persons not members, having prepared papers to be presented at 
the meetings of the Association, shall be proposed for membership at the 
first business meeting of the Association. 

EXPENDITURES. 

15. All bills connected with the publication of the Transactions shall, 
upon the approval of the chairman of the Publication Committee and 
the Secretary, be signed by the President of the Association, and paid 
by check of the Treasurer directly to the party concerned ; and the Pres- 
ident shall not approve any bill, relating either to publishing or printing. 



BY-LAWS. 307 

without the approval first of the chairman of the committee in charge 
thereof. 

16. Bills for current expenses shall be first approved by the Secretary » 
then sent to the President, and on his approval they shall be paid by 
check of the Treasurer directly to the parties interested. 

17. The actual and necessary travelling expenses of the Secretary and 
Treasurer to the annual meeting of the Association, and to one meeting 
of the Executive Committee, shall be classed as current expenses. 

RBSOLUTIONS. 

18. All resolutions presented to the Association shall be sent to the 
Chair in writing, and referred to a committee without discussion. 

ARREARAGES. 

19. The arrearages of all members remitting their dues for two years 
shall be cancelled up to the date of the last payment, but they shall be 
entitled to the Transactions of the Association only for the years for which 
they have actually paid. 

AUDITING COMMITTEE. 

20. An Auditing Committee shall be appointed by the Chair, to audit 
the accounts of the Treasurer, and report upon the same. 



OFFICERS AND COMMITTEES 

or TH> 

AMERICAN PUBLIC HEALTH ASSOCIATION. 



Officers, 1893-1894. 



Presidint^ .... Dr. £. P. Lachapelle, Montreal, Canada. 
First Viu-PresidiiU^ . Dr. M. Carmona y Valle, Mexico^ Mix. 
Second Vice-President^ Dr. J. N. McCormack, Bowling Green^ Ky. 
Secretary^ .... Dr. Irving A. Watson, Concord^ N. H, 
Treasurer^ .... Dr. Henry D. Holton, Brattleboro\ W. 
{Bx-<ffido members Execatiye Committee.) 



ex-presidents of the association. 

Prof. Stephen Smith New York City. 

Dr. Joseph M. Toner IVashington^ D. C 

Depaty Surgeon General John S. Billings U. S. Army, 

Prof. Robert C. Kedzie Lansings Mick, 

Medical Director Albert L. Gihon U.S. Navy. 

Dr. James E. Reeves Chattanooga^ Tenn. 

Dr. Henry P. Walcott Cambridge, Mass. 

Surgeon General George M. Sternberg U. S. Army. 

Dr. Charles N. Hewit^ Red IVing, Minn. 

Dr. Henry B. Baker, Lansings Mich. 

T>T. Frederick Montizambert Quebec, Canada. 

Dr. Felix Formento JVew Orleans, La. 

Dr. Samuel H. Duroin Boston, Mass. 

(The ex-Presidents, ex-officio members Executive Committee.) 



STANDING COMMITTEES. 
executive committee. 

(Elective.) 

Dr. William Bailey LauisvUle, Ky. 

Dr. Henry F. Hoyt St. Paul, Minn. 

Roberto Gayol, C. E Mexico, Mex. 

Dr. James T. Reeve Appleton, Wis. 

Dr. Eduardo Lic^aga Mexico, Mex. 

Dr. PiNCKNEY Thompson Henderson, Ky. 



OFFICERS AND COMMITTEES. 



309 



United States 
Alabama, . 
Arkansas, . 
California, . 
Colorado, . 
Connecticut, 
Delaware, . 
Florida, 
Georgia, 
Illinois, 
Indiana, 
Iowa, . . 
Kansas, 
Kentucky, . 
Louisiana, . 
Maine, . . 
Maryland, . 
Massachusetts, 
Michigan, . 
Minnesota, 
Mississippi, 
Missouri, . 
Nebrasksi, . 
New Hampshire, 
New Jersey, 
New Mexico, 
New York, . 
North Carolina, 
North Dakota, 
Ohio, . . . 
Oklahoma Ter., 
Pennsylvania, . 
Rhode Island, . 
South Carolina, 
South Dakota, . 
Tennessee, 
Texas, . . . 
Vermont, . . 
Virginia, . . 
Washington, . 
West Virginia, 
Wisconsin, . . 
Dist. of Columbia, 
U. S. Army, 
U. S. Navy, 
U. S. M. H. Service, 

Canada: 

Dominion of Canada, 
Province of Ontario, 
Province of Quebec, 
Manitoba, .... 



ADVISORY COUNCIL. 

Dr. Jerome Cochran, Mobile, 
Dr. H. C. DuNNAVANT, Osceola, 
Dr. Charles A. Ruggles, Stockton, 
Dr. Henry K. Steele, Denver, 
Dr. R. S. Goodwin, Thomaston. 

Dr. Joseph Y. Porter, Key West, 

Dr. William F. Brunner, Savannah, 

Dr. Sarah Hackett Stevenson, Chicago, 

Dr. J. S. Arwine, Columbus, 

Dr. J. F. Kennedy, Des Moines, 

Dr. Daniel C. Jones, Topeka, 

Dr. George Beeler, Clinton. 

Dr. LuciEN F. Salomon, New Orleans, 

Dr. A. G. Young, Augusta, 

Dr. John Morris, Baltimore, 

Dr. Samuel W. Abbott, Wakefield, 

Dr. Henry B. Baker, Lansing, 

Dr. Charles N. Hewitt, Red Wing, 

Dr. Wirt Johnston, Jackson, 

Dr. A. M. Crow, Kansas City. 

Dr. Frederick D. Haldeman, Ord, 

Dr. J. J. Berry, Portsmouth, 

Dr. A. Clark Hunt, Trenton, 

Dr. Friend Palmer, Cerrillos. 

Dr. John Griffin, Brooklyn, 

Dr. Henry I. Bahnson, Salem, 

Dr. O. Wellington Archibald, Jamestown, 

Dr. C. O. Probst, Columbus. 

Dr. Charles F. Waldron, Oklahoma City. 

Dr. Benjamin Lee, Philadelphia. 

Dr. Charles V. Chapin, Providence, 

Dr. T. Grange Simons, Charleston. 

Dr. K. M. O. Teigen, Fargo, 

Dr. J. Berrien Lindsley, Nashville. 

Dr. R. M. SWEARINGEN, Austin. 

Dr. George S. Foster, Putney, 

Prof. John B. Minor, University of Virginia, 

Dr. G. S. Armstrong, Olympia, 

Dr. Louis D. Wilson, Wheeling. 

Dr. U. O. B. WiNGATE, Milwaukee. 

D. E. Salmon, D. V. M., Washington. 

Dep. Surg. Gen. A. A. Woodhull, Hot Springs, Ark, 

Medical Director Albert L. Gihon, Washington, D. C. 

Surgeon P. H. Bailhache, San Francisco, Cal, 

Dr. Frederick Montizambert, Quebec. 
Dr. Peter H. Bryce, Toronto, 
Mr. Henry R. Gray, Montreal. 
Dr. J. H. O'DONNELL, Winnipeg. 



3IO OFFICERS AND COMMITTEES. 

New Brunswick, ... Dr. Wm. S. Harding, St, John. 

Nova Scotia, .... Dr. A. P. Reid, Halifax. 
Mexico: 

Aguascalientes, ... Dr. Agustin Chacon, Mexico. 

Campeche, .... Dr. Jose T. Ferrer, Mexico^ Mex. 

Colima, Dr. Eug^nio Z. Gomez, CoUma. 

Coahuila, ..... Dr. Dionisio Garcia Fuentes, SaltUlo. 

Chihuahua, .... Dr. Miguel Marquez, Chihuahua. 

Chiapas Dr. Francisco Marin, Puebla. 

Durango, Dr. Fernando Zarraga, Mexico^ Mex. 

Guanajuato, .... Dr. Eduardo Lic^ga, Mexico^ Mex. 

Guerrero, Dr. Domingo OrvaI^anos, Mexico^ Mex. 

Hidalgo Dr. Luis Ruiz, Mexico. 

Jalisco Dr. Juan Zavala, Guadalajara. 

Michoac^n, .... Dr. Roque Macouzet, Mexico^ Mex. 

Morelos, Dr. Angel GaviSTo, Mexico^ Mex. 

Mexico, Dr. Alberto Espinosa, Pachuca. 

Nuevo Ledn, .... Dr. Tomas Noriega, Mexico^ Mex. 

Oaxaca, Dr. Demetrio Mexia, Mexico^ Mex. 

Puebla Dr. Angel Contreras, Puebla. 

Quer^taro, Dr. Manuel Septien, Queritaro. 

San Luis Potosf, ... Dr. Jesus Monjaras, San Luis Potosi. 

Sonora, Dr. Alberto Noriega, Hermosillo. 

Sinaloa, Dr. Ramon Icaza, Mexico^ Mex. 

Tabasco, Dr. Eduardo Garcia, Mexico Mex. 

Tamaulipas, .... Dr. T. Martinez Calleja, C. Victoria. 

Tlazcala, Dr. Jose Terres, Mexico, Mex. 

Vera Cruz, Dr. Gregorio Mendizabal, Orirsaba. 

Yucatan, Dr. Jose Peon Contreras, Mexico. 

Zacatecas, Dr. Washington Matxet Prevost, Mexico, Mex. 

Territorio de la BajaCalif *, Dr. Federico Cota, La Paz. 

Territorio de Tepic, . . Dr. Juan H. Revueltas, Tepic. 

Distrito Federal, ... Dr. Manuel Carmona y Valle, Mexico, Mex. 



SPECIAL COMMITTEES. 
publication committee. 

Dr. Irving A. Watson Concord, N. H. 

Dr. Granville P. Conn Concord, N. H. 

Dr. Samuel W. Abbott Wakefield, Mass. 

ON THE POLLUTION OF WATER-SUPPUBS. 

Major Charles Smart, U. S. A Washington, D. C. 

Prof. Victor C. Vaughan Ann Arbor, Mich. 

George W. Fuller. B. S Lawrence. Mass. 

Dr. Maurice Perkins Schenectady, N. Y. 

Dr. Josji Ramirez Mexico, Mex. 

Dr. Wyatt Johnson Montreal, P. Q. 



OFFICERS AND COMMITTEES, 3 1 1 

ON THE DISPOSAL OP QARBAGB AND REFUSE. 

Rudolph Hering, C. E 277 Pearl St., New York City. 

Prof. Delos Fall Albion, Mich. 

Dr. Louis Laberge Montreal, P. Q. 

Dr. Edward Clark Buffalo, N. Y. 

Dr. Juan J. Ramirez de Arellano Mexico, Mex. 

ON ANIMAL diseases AND ANIMAL FOOD. 

D. E. Salmon, D. V. M Washington, D. C. 

Prof. James Law Ithaca, N. Y. 

Prof. Josi L. GoifEZ Mexico, Mex. 

Dr. Henry F. Hoyt St. Paul, Minn. 

Dr. PiNCKNEY Thompson Henderson, Ky. 

ON NOMENCLATURE OF DISEASES AND FORMS OF STATISTICS. 

Dr. Samuel W. Abbott Wakefield, Mass. 

Dr. Jesus E. Monjaras San Luis Potosi, Mex. 

Dr. £lz£ar Pelletier Montreal, P. Q. 

Prof. Charles A. Lindsley New Haven, Conn. 

Dr. Charles N. Hewitt Red Wing, Minn. 

ON PROTECTIVE INOCULATIONS IN INFECTIOUS DISEASES. 

Surgeon-General George M. Sternberg, U. S. A. . . Washington, D. C. 

Prof. Victor C. Vaughan Ann Arbor, Mich. 

Dr. Geo. H. F. Nuttall Baltimore, Md. 

Dr. M. Carmona y Valle Mexico. Mex. 

Dr. Agustin Reyes Mexico, Mex. 

ON national health legislation. 

Dr. Henry P. Walcott Cambridge, Mass. 

(With authority to select associates.) 

ON THE CAUSE AND PREVENTION OF DIPHTHERIA. 

Dr. George C. Ashmun Cleveland, O. 

Dr. Peter H. Bryce Toronto, Ont. 

Dr. Juan Ramirez de Arellano Mexico, Mex. 

Dr. John H. McCollom Boston, Mass. 

Dr. Mendoza Lopez Guadalajara, Mex. 

ON CAUSES AND PREVENTION OF INFANT MORTALITY. 

Dr. Charles N. Hewitt Red Wing, Minn. 

(With authority to select associates.) 

ON restriction and PREVENTION OF TUBERCULOSIS. 

Dr. J. N. McCoRMACK Bowling Green, Ky. 

Dr. Lawrence F. Flick Philadelphia, Pa. 

Dr. Henry B. Baker Lansing, Mich. 

Dr. Eduardo Lic^ga Mexico, Mex. 

Dr. J. A. Beaudry Montreal, P. Q. 



312 OFFICERS AND COMMITTEES, 

ON CAR SANITATION. 

Dr. Granville P. Conn Concord, N. H. 

Prof. W. W. Daniells Madison, Wis. 

Dr. R. Harvey Reed Mansfield, O. 

£. C. Jordan, C. £. . Portland, Me. 

Dr. DoBONGO OrvaI^anos Mexico, Mex. 

international committee on the prevention op the spread of yellow- 
fever. 

Dr. Felix Formento New Orleans, La. 

Surgeon-General George M. Sternberg, U. S. A., . . . Washington, D. C. 

Dr. Eduardo Licf aoa Mexico, Mex. 

Dr. Manuel Carmona y Valle Mexico, Mex. 

Dr. Jerome Cochran Mobile, Ala. 

Dr. Samuel R. Oluphant New Orleans, La. 

Mr. Alfred V. Wood Brunswick. Ga. 

ON THE CENTENNIAL OF VACCINATION. 

Dr. Joseph M. Toner Washington, D. C. 

Dr. T. Grange Simons Charleston, S. C. 

Prof. Charles A. Lindsley New Haven, Conn. 

Dr. Angel Contreras Puebla, Puebla, Mex. 

Dr. R. Harvey Reed Mansfield, O. 

ON INCORPORATION. 

Dr. Emmanuel P. Lachapblle, President Montreal, P. Q. 

Dr. Irving A. Watson, Secretary Concord, N. H. 

Dr. Henry D. Holton, Treasurer Brattleboro', Vt. 

Major Charles Smart, U. S. A Washington, D. C. 

Deputy Surgeon General John S. Billings, U. S. A. . . . Washington, D. C. 

Medical Director Albert L. Gihon, U. S. N Washington, D. C. 

Dr. Smith Townshend Washington, D. C. 

Dr. Walter Wyman, Supervising Surg, Gen^ U. S. M. H. S., Washington, D. C. 

chairman local committee OF arrangements. 

President, Dr. Robert Craik Montreal, P. Q. 

Secretary, Dr. Elzear Pelletier, 76 St. Gabriel St. ... Montreal, P. Q. 



REVISED LIST OF MEMBERS 

AMERICAN PUBLIC HEALTH ASSOCIATION, 

1894. 



This list includes all those who have maintained their membership to the present time, excepting 
those elected at Chicago, which Ibt will be found in another place. The Secretary should be notified 
of any errors or omissions. 

PRESIDENTS OF THE ASSOCIATION. 

Stephen Smith, M. D 1872, '73. '74 

Joseph M. Toner, M. D 1875 

♦Edwin M. Snow, M. D 1876 

♦John H. Rauch, M. D 1877 

♦Elisha Harris, M. D 1878 

♦James L. Cabell, M. D . 1879 

John S. Billings, M. D 1880 

♦Charles B. White, M. D 1881 

Robert C. Kedzie, M. D 1882 

♦Ezra M. Hunt, M. D 1883 

Albert L. Gihon, M. D 1884 

James E. Reeves, M. D 1885 

Henry P. Walcott, M. D 1886 

George M. Sternberg, M. D 1887 

Charles N. Hewitt, M. D 1888 

♦HosMER A. Johnson, M. D. . 1889 

Henry B. Baker, M. D 1890 

Frederick MoNTizAMBERT, M. D 1891 

Felix FoRMENTO, M. D . 1892 

Samuel H. Durgin, M. D 1893 

Emmanuel P. Lachapelle, M. D 1894 

active MEMBERS. 

Dr. Alex C. Abbott Baltimore, Md. 1889 

Dr. Samuel W. Abbott Wakefield, Mass. 1882 

Dr. C. A. Abernathy Pulaski, Tenn. 1891 

Dr. Enrique L. Abogado, Plaza de San Juan 17 . . .' Mexico, Mex. 1892 

Dr. Edward Thomas Abrams Dollar Bay, Mich. 1891 

Dr. A. Aceves, Bastrillo 12 Guadalajara, Jalisco, Mex. 1892 

Dr. Julio Castillo y Adalid, San Juan de Letrdn 9 . . Mexico, Mex. 1892 

Dr. Charles W. Adams Kansas City, Mo. 1891 

* Deceased. 



314 REVISED LIST OF MEMBERS. 

Julius W. Adams, C. E., Congress St Brooklyn, N. Y. 1889 

Dr. J. F. A. Adams Pittsfield, Mass. 1881 

Dr. iGNACio Aguado Toluca, Mex. 1892 

Dr. Manuel C. Aguilar Zacatecas, Zacatecas, Mex. 1 892 

Dr. J. Aguilar Hermosillo, Sonora, Mex. 1892 

Dr. Juan P. Aguilar . Merida, Yucatan, Mex. 1892 

Dr. Alberto Aizpuru Mexico, Mex. 1892 

Dr. Rafael AizPURU, Vergara 10 Mexico, Mex. 1892 

Dr. Luis G. Alcantara Irapuato, Guanajuato, Mex. 1892 

C. H. Alden. U. S. a St. Paul, Minn. 1887 

Dr. Edward Alexander El Paso, Tex. 1892 

Dr. Jose Alfaro Vera Cruz, Vera Cruz, Mex. 1892 

Dr. L. Alfaro Mexico, Mex. 1892 

Edwin R. Allen, V. S Kansas City, Mo. 1891 

Dr. John M. Allen Liberty, Mo. 1891 

Dr. Norman Allen Toronto, Ont. 1891 

Dr. Willis G. Alling New Haven, Conn. 1885 

Dr. Antonio F. Alonso Mexico, Mex. 1892 

Dr. Fernando Altamira, San Felipe 2 Mexico, Mex. 1892 

Dr. Fernando Altamirano Guadalupe, Fed. Dis., Mex. 1892 

Dr. Charles D. Alton, 86 Farmington Ave. . . . Hartford, Conn. 1890 

Dr. F. Alvarez Mexico, Mex. 1892 

Dr. Francisco Alvarez Oaxaca, Oaxaca, Mex. 1892 

Dr. Tostado Teofilo Alvarez .... Guadalajara, Jalisco, Mex. 1892 

Dr. Austin White Alvord Battle Creek, Mich. 1887 

Dr. Charles Ambrook Boulder, Col. 1878 

Dr. AzEL Ames, Jr Chicago, 111. 1875 

Dr. A. A. Ames Minneapolis, Minn. 1887 

Dr. Howard E. Ames, P. A. Surgeon U. S. Navy, 

Museum of Hygiene Washington, D. C. 1890 

Dr. Manuel de Anaya, Plaza Mayor 18 . Guanajuato, Guanajuato, Mex. 1892 

Dr. James C. Anderson Granger, Tex. 1892 

John A. Anderson Lambertville, N. J. 1887 

Dr. Warren E. Anderson, ii W. Government St. . Pensacola, Fla. 1892 

Dr. Winslow Anderson, 603 Sutter St San Francisco, Cal. 1892 

Dr. Nemorio Andrade Pachuca, Hidalgo, Mex. 1892 

Dr. R. Andrade Merida, Yucatan, Mex. 1892 

Prof. Edmund R. Angell Derry, N. H. 1889 

George T. Angell, Esq Boston, Mass. 1878 

Dr. F. Araujo Mexico, Mex. 1892 

Dr. O. W. Archibald Jamestown, N. D. 1888 

Dr. E. Armendariz Mexico, Mex. 1892 

Dr. S. T. Armstrong, 166 W. 54th St. . •. . . . New York City. 1892 

Dr. Leandro Arroyo S. Angel, Mexico, Mex. 1892 

Dr. J. S. Arwine Columbus, Ind. 1882 

Dr. G. C. Ashmun Cleveland, Ohio. 1881 

Dr. William A. Atchison, 132 No. Spruce St. . . . Nashville, Tenn. 1892 

Hon. Edward Atkinson Boston, Mass. 1889 

Prof. Edwin C. Atkinson, 733 Broadway New York City. 1892 

Dr. Robert C. Atkinson, 1649 So. Jefferson Ave. . . St. Louis, Mo. 1892 



REVISED LIST OF MEMBERS, 315 

Prof. W. O. Atwater Washington, D. C. 1889 

Dr. H. W. Austin, U. S. M. H. S Washington, D. C. 1880 

Dr. Manuel AvELEYRA, Alfaro 7 Mexico, Mex. 1892 

Dr. James F. Aydelotte Decaturville, Tenn. 1891 

Dr. Stephen C. Ayers, 64 W. 7 St Cincinnati, Ohio. 1892 

Dr. James Woods Babcock Columbia, S. C. 1891 

Dr. William Bailey Louisville, Ky. 1879 

Dr. William C. Bailey, 614 Walnut St Knoxville, Tenn. 1892 

Dr. William O. Bailey, 7464th Ave Louisville, Ky. 1892 

Dr. P. H. Bailhache, U. S. M. H. S San Francisco, Cal. 1874 

Dr. Henry B. Baker Lansing, Mich. 1873 

Dr. Henry L Bahnson Salem, N. C. 1888 

Dr. Lewis Balch Albany, N. Y. 1888 

Dr. F. Bancroft Denver, Col. 1887 

Louis J. Barbot, C. E Charleston, S. C. 1890 

Sr. Mariano Barcena, Director del Observatorio Central . Mexico, Mex. 1892 

Dr. William E. Barker Chanute, Kan. 1892 

Dr. Tom C. V. Barkley, 600 Market St Chattanooga, Tenn. 1892 

Dr. Manuel Barreiro Mexico, Mex. 1892 

Dr. T. G. Barnhill Findlay, Ohio. 1882 

James W. Bartlett Dover, N. H. 1888 

Dr. Samuel W. Battle, U. S. A Asheville, N. C. 1887 

Dr. Elias Hudson Bartley, 21 Lafayette Ave. . . . Brooklyn, N. Y. 1890 

Edward Bausch Rochester, N. Y. 1884 

Mr. William P. Baum, Roup St Pittsburgh, Pa. 1892 

Dr. Jose Baviera Durango, Durango, Mex. 1892 

Dr. R. O. Beard Minneapolis, Minn. 1888 

Dr. Benjamin Franklin Beardsley Hartford, Conn. 1889 

Dr. J. A. Beaudrey, 65 St. Denis St Montreal, P. Q. 1889 

Dr. C. W. Beaumont . Qarksville, Tenn. 1891 

Dr. Frederick Becker Clermont, Iowa. 1889 

Dr. W. F. Becker Milwaukee, Wis. 1888 

Dr. D. H. Beckwith Cleveland, Ohio. 1884 

Dr. Henry E. Beebe ' . . . Sidney, Ohio. 1882 

Dr. A. N. Bell, 291 Union St Brooklyn, N. Y. 1872 

Dr. Harry Kejit Bell Brooklyn, N. V. 1888 

George N. Bell, C. E Philadelphia, Pa. 1889 

Sr. Carlos Bello Puebla, Puebla, Mex. 1892 

Dr. Francisco Bello Puebla, Puebla, Mex. 1892 

Dr. M. Benitez Guadalajara, Jalisco, Mex. 1892 

Dr. Thomas Joshua Bennett, 105 W. 7th St Austin, Tex. 1892 

Dr. John T. Berghoff, 215 S. 6th St St. Joseph, Mo. 1892 

Dr. Francisco Bernaldez, Estampa-Merced 5 . . . . Mexico, Mex. 1892 

Dr. John J. Berry Portsmouth, N. H. 1886 

Dr. John S. Billings. U. S. A Washington, D. C. 1872 

Dr. W1LLLA.M T. Bishop Harrisburg, Pa. 1889 

Dr. Mary Taylor Bissell, 19 E. 46th St New York City. 1889 

Dr. John E. Black Memphis, Tenn. 1887 

C. H. Blackburn, Esq., 512 Colerain Ave Cincinnati, Ohio. 1889 

Dr. Emily Blackwell, 53 E. 20th St New York City. 1873 



3l6 REVISED LIST OF MEMBERS. 

Dr. Daniel B. Blake Cuero, Tex. 1892 

Dr. John P. Blankenship Maryville, Tenn. 1891 

Dr. F. Blasquez, i« Guerrero 14 Mexico, Mex. 1892 

E. W. Blatchford, 375 No. La Salle St Chicago, 111. 1876 

Dr. Joaquin Blengio Campeche, Campeche, Mex. 1892 

Dr. Delavan Bloodgood, U. S. N Brooklyn, N. Y. 1890 

Dr. Thomas Blauch Bloomfield Westbrook, Conn. 1889 

Dr. Frans H. Bodenius Madison, Wis. 1888 

Benjamin Meade Bolton, Hoagland Lab'y, Montague St., Brooklyn, N.Y. 1889 

Dr. Moses H. Bonner Nashville, Tenn. 1891 

Dr. C. E. Booth Winnebago, Wis. 1888 

Dr. Arthur Bosauko Leadville, Col. 1891 

Dr. Seth D. Bowker Kansas City, Mo. 1891 

Frederick N. Boxer, C. E Montreal, P. Q. 1885 

Mr. William H. Boyer, 47 Leonard St New York City. 1892 

Dr- S. B. Boyd Knoxville, Tenn. 1891 

Dr. George F. Bradley, 287 W. 12th St Chicago, 111. 1892 

Joseph H. Brady, 1331 Walnut St Kansas City, Mo. 1891 

Dr. Julius Braunnagel, 250 South Laredo St. . . San Antonio, Tex. 1890 

Dr. Alfonzo Bray Mexico, Mex. 1892 

Dr. Juan BreS^a, Tacuba 85 Zacatecas, Mex. 1892 

Dr. F. W. Brewer Chicago, 111. 1892 

Prof. William H. Brewer New Haven, Conn. 1874 

Dr. OsHEA Stowell Brigham, 1704 Washington St. . . Toledo, Ohio. 1892 

Dr. M. D. Brochu, 130 St. Francis St Quebec, P. Q. 1889 

Dr. Benjamin T. Brodie Detroit, Mich. 1888 

Dr. George W. Brooke Ellsworth, Ohio. 1892 

Joseph O. Brown Pittsburgh, Pa. 1888 

Dr. John M. Browne, U. S. N Washington, D. C. 1883 

Dr. William Francis Brunnbr, 50 Harris St Savannah, Ga. 1890 

Dr. Peter H. Bryce Toronto, Ont. 1883 

Dr. Erastus J. Buck Platteville, Wis. 1888 

Dr. Felipe Buenrostro Mexico, Mex. 1892 

Dr. Juan BuENROSTRO Y Collantes Mexico, Mex. 1892 

Dr. John Robinson Buist, 151 N. Spruce St. . . . Nashville, Tenn. 1892 

Dr. J. SoMERS Buist Charleston, S. C. 1890 

Hon. T. B. BULLENE Kansas City, Mo. 1891 

Dr. Charles Jenkins Burroughs, 119 W. Church St. . Jacksonville, Fla. 1892 

Dr. Fletcher A. Butler Harvard, Neb. 1892 

Dr. George D. Butler Pulaski, Tenn. 1892 

Dr. Antonio Butron Acapulco, Guerrero, Mex. 1892 

Dr. Edsil Walton Buchanan West Bend, Iowa. 1892 

Dr. J. Grattan Cabell Richmond, Va. 1873 

Dr. Juan Cabello y Siller Saltillo, Coahuila, Mex. 1892 

Dr. E. Cacho Mexico, Mex. 1892 

Dr. Juan Calderon Puebla, Puebla, Mex. 1892 

Dr. Jose Maria Calderon Puebla, Puebla, Mex. 1892 

Dr. Frank Hawkins Caldwell Sanford, Fla. 1892 

Dr. John H. Callender Nashville, Tenn. 1891 

Dr. Allan Cameron Owen Sound, Ont. 1886 



REVISED LIST OF MEMBERS, 317 

Dr. James Campbell Hartford, Conn. 1888 

Or. Michael Campbell Knoxville, Tenn. 1891 

Dr. A. L. del Campo Lagos, Jalisco, Mex. 1892 

Sr. Manuel Galban Campos Mexico, Mex. 1892 

Dr. Juan M. Campos Toluca, Mex. 1892 

Dr. R. CA5fEDO Apizaco, Tlaxcala, Mex. 1892 

Mr. George Turner Cann, 116 Bryan St Savannah, Ga. 1892 

Dr. William Canniff Toronto, Ont. 1883 

Dr. G. M. D. Cantrell Little Rock, Ark. 1881 

Dr. A. W. Cantwell Davenport, Iowa. i88c 

Dr. Rafael Caraza Mexico, Mex. 1892 

Dr. Antonio J. Carbajal, San Fernando 3 Mexico, Mex. 1892 

Dr. Santa Maria Carlos Durango, Durango, Mex. 1892 

Dr. Bonifacio Carmona Queretaro, Queretaro, Mex. 1892 

Dr. Manuel Carmona y Valle Mexico, Mex. 1892 

Dr. James G. Carpenter Stanford, Ky. 1892 

Dr. J. A. Carranza Morelia, Michoacan, Mex. 1892 

Dr. Enrique Carrera, £ncarnaci6n 10 Mexico, Mex. 1892 

Dr. A. Carrillo Nuevo Leon, Monterey, Mex. 1892 

Dr. Filberto Carriles • . . Aguascalientes, Aguascalientes, Mex. 1892 

Dr. H. R. Carter, U. S. M. H. S Washington, D. C. 1890 

Dr. Gabriel J. Casillas Puebla, Puebla, Mex. 1892 

Dr. ToMAS Casillas Guanajuato, Guanajuato, Mex. 1892 

Dr. Adolfo Casta5^ares Tabasco, Tabasco, Mex. 1892 

Dr. Alfonso Castillo Toluca, Mex. 1892 

Dr. Ramon Castillo Oaxaca, Oaxaca, Mex. 1892 

Dr. Lucas Castro Mexico, Mex. 1892 

Dr. S. Cervantes Mexico, Mex. 1892 

Dr. Agustin Chacon, Ortega 10 Mexico, Mex. 1892 

Prof. Stanford E. Chaille New Orleans, La. 1874 

Dr. Carlos Chaix Toluca, Mex. 1892 

Dr. Charles W. Chancellor Baltimore, Md. 1875 

Prof. C. F. Chandler, 49th St. and 4th Ave. . . . New York City. 1872 

Dr. Charles V. Chapin Providence, R. L 1886 

Dr. Walter H. Chapin Springfield, Mass. 1889 

John C. Chase, C. E Wilmington, N. C. 1890 

Dr. iGNACio Chavez, Jesiis Maria Mexico, Mex. 1892 

Dr. Lorenzo Chavez Mexico, Mex. 1892 

Dr. ToMAS Chavez, Leandro Valle i . Guanajuato, Guanajuato, Mex. 1892 

Dr. Jesus Chico, 2 EstrellaSt. . . Guanajuato City, Guanajuato, Mex. 1891 

Dr. George W. Christian Burnet, Texas. 1892 

Dr. Thomas Teasdale Church, 70 E. Main St. . . . Salem, Ohio. 1890 

Hon. J. W. Clapp Memphis, Tenn. 1879 

Dr. Edwin Clark Buffalo, N. Y. 1888 

Dr. A. P. Clarke Cambridge, Mass. 1887 

Dr. Frank H. Clarke Lexington, Ky. 1892 

Dr. E. F. X. Cleveland Dundee, 111. 1887 

Dr. A. A. Clough Denver, Col. 1889 

Dr. Jerome Cochran Mobile, Ala. 1878 

Dr. Charles E. Cole ' . . . . Wauzeka, Wis. 1888 



3l8 REVISED LIST OF MEMBERS, 

Dr. Edward W. Cole Nashville, Tenn. 1887 

Dr. N. B. Cole Bloomington, 111. 1888 

Dr. William C. Cole Attica, Ind. 1892 

Dr. Milton H. Collins, Health Officer ... So. Charleston, Ohio. 1892 

Dr. F. H. COLTON Brooklyn, N. Y. 1889 

Dr. G. P. Conn Concord, N. H. 1875 

Dr. P. S. Conner Cincinnati, Ohio. 1884 

Dr. Henry J. Connor West Superior, Wis. 1884 

Dr. Leartus Connor, 103 Cass St Detroit, Mich. 1892 

Dr. Angel Contreras, Mesones 7 . . . . Puebla, Puebla, Mex. 1892 

Dr. DiODORO Contreras Vera Cruz, Vera Cntz, Mex. 1892 

Dr. Isaac Cooper, 194 Broad St Trenton, N. J. 1889 

Dr. George Walter CoPELAND Middleborough, Mass. 1892 

Dr. John C. CORBUS Mendota, 111. 1889 

Dr. M. CoRDERO Mexico, Mex. 1892 

Dr. William T. Corlett, 333 Prospect St Cleveland, Ohio. 1892 

Dr. Aaron Cornish, 15s William St New Bedford, Mass. 1892 

Dr. A. CORONADO, Puerto Nuevo 7 Mexico, Mex. 1892 

Dr. N. CoRONADO Ixtlan, Terr. Tepic, Mex. 1892 

Dr. Antonio J. CoRREA Mexico, Mex. 1892 

Dr. Delgado J. CoRREA Zacatecas, Zacatecas, Mex. 1892 

Dr. Federico Cota La Paz, Baja Cal, Mex. 1 892 

Dr. Carros Cortez, 2* Ancha 5 Mexico, Mex. 1 892 

Julius CoTz, S. E Atlantic City, N. J. 1889 

Dr. W. T. Councilman Baltimore, Md. 1887 

Dr. John Coventry Windsor, Ont. 1886 

Dr. C. W. CovERNTON Toronto, Ont. 1884 

Dr. J. B. Cowan Tullahoma, Tenn. 1891 

Dr. G. G. Craig Rock Island, 111. 1880 

Dr. Milton P. Creel Central City, Ky. 1892 

J. James R. Croes, C. E., 13 William St New York City. 1877 

Algernon S. Currey, Esq Trenton, Tenn. 1891 

Dr. David M. Currier Newport, N. H. 1883 

Dr. F. C. Curtis Albany, N. Y. 1883 

Dr. Charles O. Curtman St. Louis, Mo. 1884 

Dr. William P. Cutler, 1227 Michigan St. . . Kansas City, Mo. 1891 

Dr. Jacob DaCosta Philadelphia, Pa. 1874 

Dr. Colonel Thomas Dahlen Dundee, 111. 1892 

Dr. J. P. Dake . Nashville, Tenn. 1879 

Dr. A. A. Dance Hamilton, Bermuda. 1892 

Dr. R. P. Daniell Jacksonville, Fla. 1890 

Prof. W. W. Daniells Madison, Wis. 1886 

Dr. H. C. Darby Wilmot, Wis. 1888 

Dr. HiRAM'H. Darr Caldwell, Tex. 1883 

Dr. James Darrach Germantown, Pa. 1874 

Dr. B. F. Davenport, 116 Tremont St Boston, Mass. 1884 

J. J. Davenport, Esq., 309 Massachusetts Building Kansas City, Mo. 1891 

Dr. Frederick Francis D'Avignon Leadville, Col. 1891 

Dr. G. Davila Puebla, Puebla, Mex. 1892 

Chester B. Davis, C. E., The Rookery Chicago, 111. 1886 



REVISED LIST OF MEMBERS. 319 

Prof. Floyd Davis, Ph. D Socorro, N. M. 1890 

Dr. N. S. Davis, 291 Huron St Chicago, 111. 1887 

Dr. Thomas Spencer Dawes, 245 Main St Saugerties, N. Y. 1891 

Dr. DwiGHT VV. Day Eau Claire, Wis. 1888 

Dr. Richard H. Day, 214 5th St Baton Rouge, La. 1892 

Dr. Simon P. Deahofe, 191 High St Mineral Point, Wis. 1892 

Dr. John H. Dearborn, 265 Cabot St Beverly, Mass. 1891 

Dr. Louis S. Deforest New Haven, Conn. 1889 

Dr. William Deming Litchfield, Conn. 1888 

Dr. Laban Dennis Newark, N. J. 1877 

Prof. J. E. Denton, Stevens Institute of Technology . Hoboken, N. J. 1891 

Dr. GusTAVus Devron New Orleans, La. 1878 

Dr. William B. Dewees, 542 South Santa F6 Ave. . . Salina, Kan. 1891 

Dr. Oscar C. DeWolf Chicago, 111. 1880 

Dr. Barriga Placido Diaz Puebla, Puebla, Mex. 1892 

Dr. Barriga Rafael Diaz Mexico, Mex. 1892 

Dr. Gonzalez Jose DE Jesus Diaz .... Puebla, Puebla, Mex. 1892 

Dr. Jesus Diaz de Leon, Apartado 2 . . . . Aguascalientes, Mex. 1892 

Dr. LozANO J. Diaz Cuantitlan, Mex. 1892 

David B. Dick Toronto, Ont. 1886 

Hon. Perez Dickinson Knoxville, Tenn. 1881 

Dr. W. H. Dickinson Des Moines, Iowa. 1881 

Dr. Thomas J. Dills, 40 West Berry St. ... Fort Wayne. Ind. 1891 

Dr. William S. Disbrow Newark, N. J. 1885 

Dr. John Norman Dixon, 6th and Monroe Sts. . . Springiield, III. 1892 

Dr. Horace Oscar Dodge Boulder, Col. 1892 

William E. Dodge, Jr., II Cliff St New York City. 1874 

Dr. Manuel Dominguez Mexico, Mex. 1892 

Dr. Alcacio Donaciano y Cano Mexico, Mex. 1892 

Dr. George Henry Donahue Northport, R. I. 1892 

Dr. Florence O. DoNOHOE S}Tacuse, N. Y. 1891 

Dr. G. T. DooLiTTLE New Haven, Conn. 1887 

Dr. John P. Douglas Bolivar, Tenn. 1891 

Dr. Richard Douglass Nashville, Tenn. 1892 

Dr. Oliver M. Doyle Seneca, So. Carolina. 1892 

Dr. John C. Dozier Birmingham, Ala. 1887 

George A. Drake Rozellville, Wis. 1889 

Dr. G. W. Drake, Walnut St Chattanooga, Tenn. 1892 

Dr. F. W. Draper, 304 Marlborough St Boston, Mass. 1887 

Dr. Thomas M. Drown, Institute of Technology . . . Boston, Mass. 1887 

Dr. Charles B. Dudley Altoona, Pa. 1888 

Dr. John E. Duffel Donaldsonville, La. 1880 

Dr. Samuel P. Duffield Dearborn, Mich. 1887 

Dr. BuRWELL Alexander Duncan West Point, Miss. 1892 

Dr. James A. Duncan, 1 107 Broadway Toledo, Ohio. 1892 

Ernest S. Dundas, V. S., 11 1 W. 14th St Kansas City, Mo. 1891 

Dr. J. C. Dunn Pittsburgh, Pa. 1885 

Dr. H. C. DuNNAVANT Osceola, Ark. 1882 

Dr. John A. Dunwoody, 200 J Newcastle St. ... Brunswick, Ga. 1892 

Dr. Samuel H. Durgin, 12 Beacon St Boston, Mass. 1875 



320 REVISED LIST OF MEMBERS. 

Sr. Jose Duvallon, Pet. Alvarado 24} Mexico, Mez. 1892 

Dr. Benjamin Franklin Eads Marshall, Tex. 1892 

Dr. Charles Richard Earley Ridgeway, Penn. 1892 

Hon. L. B. Eaton Memphis, Tenn. 1880 

Mr. H. C. EcCLES Charlotte, N. C. 1892 

Dr. J. Antonio de Echavarri Mexico, Mex. 1892 

Dr. Wallace E. Edgerton Salem, S. D. 1892 

Dr. Cyrus Edson, 54 W. 9th St New York City. 1889 

Dr. John B. Edwards Mauston, Wis. 1888 

Holden C. Edwards Mineral Point, O. 1892 

Dr. Joseph F. Edwards, 224 So. i6th St Philadelphia, Pa. 1884 

Dr. RiCARDO Egea Mexico, Mex. 1892 

Dr. Edward F. Elbridge New London, Wis. 1888 

Dr. John Elsner Denver, Col. 1887 

Dr. Gregorio Encinas Puebla, Puebla, Mex. 1892 

Andrew Engle Des Moines, Iowa. 1888 

Dr. Juan Enriguez Chihuahua, Mex. 1892 

Dr. Herbert D. Ensign Boone, Iowa. 1892 

Dr. Frank W, Epley New Richmond, Wis. 1888 

Dr. Alberto Escobar, II* Viotela 4 Mexico, Mex. 1892 

Dr. Manuel de Esesarte Oaxaca, Oaxaca, Mex. 1892 

Dr. F. ESPINOLA Tepic, Terr. Tepic, Mex. 1892 

Dr. Alberto Espinosa Pachuca, Hidalgo, Mex. 1892 

Dr. Bravo Ernesto Espinosa, Hospitatilo 4 . Puebla, Puebla, Mex. 1892 

Dr. Roman Estrada Tenancingo, Mex. 1892 

Dr. George L. Eyster, 1 109 Second Ave Rock Island, 111. 1891 

Prof. Delos Fall Albion, Mich. 1889 

Dr. L. A. Falligant Savannah, Ga. 188 1 

Dr. Edward Farnham Cambridge, Mass. 1889 

Dr. Philo Judson Farnsworth, 332 So. Ave. . . Clinton, Iowa. 1892 

A. B. Farquar, Esq York, Pa. 1880 

Dr. Ignacio Farquet Puebla, Puebla, Mex. 1892 

Dr. Henry Marshall Fenno, ^^ W. Main St. . . . Rochester, N. Y. 1892 

Dr. F. Ferguson, 20 W. 38th St New York City. 1892 

Dr. J. D. Fernandez Jacksonville, Fla. 1890 

Dr. Trinidad J. Ferrer, Portillo Sandiego 2 .... Mexico, Mex. 1892 

Dr. Ernesto Pablo Fichtner Mexico, Mex. 1892 

Dr. James B. Field Lowell, Mass. 1889 

Dr. J. D. Fields Manor, Tex. 1880 

Dr. Priscitiano Figueroa Guaymas, Sonora, Mex. 1892 

Dr. William M. Findley • . Altoona, Pa. 1892 

Dr. Francis W. Firmin Findlay, Ohio. 1892 

GusTAVE Fleischmann Buflfalo, N. Y. 1888 

Henry A. Fleischmann, 1 541 Madison Ave. . . . New York City. 1888 

Dr. Louis Fleischmann New York City. 1890 

Dr. C. I. Fletcher Indianapolis, Ind. 1892 

Dr. Lawrence F. Flick, 736 Pine St Philadelphia, Pa. 1890 

Dr. Oscar A. Fliesburg Hudson, Wis. 1888 

Dr. Alvarez Manuel Flores Guadalajara, Jalisco, Mex. 1892 

Dr. Peter R. Ford Memphis, Tenn. 18^7 



REVISED LIST OF MEMBERS. 321 

Dr. William H. Ford, 1622 Summer St Philadelphia, Pa. 1874 

Dr. Felix Formento New Orleans, La. 1880 

Dr. Joseph M. Fort, Austin and High Sts Paris, Tex. 1892 

Dr. Eugene Foster Augusta, Ga. 1881 

Dr. S. B. Fowler Gainesboro, Tenn. 1891 

Dr. Charles J. Fox Willimantic, Conn. 1887 

Hon. David R. Francis Jefferson City, Mo. 1891 

Dr. VisiERO Franctsco y Guerrero Mexico, Mex. 1892 

Dr. H. T. Fraser Charleston, S. C. 1880 

Dr. Spencer M. Free Du Bois, Pa. 1885 

William S. French, C. E West Newton, Mass. 1889 

Dr. Manuel de la Fuentb Teziultan, Puebla, Mex. 1892 

Dr. DiONisio Garcia Fuentes Saltillo, Coahuila, Mex. 1892 

Dr. Albert Fulton, 2353 So. Broadway .... St. Louis, Mo. 1892 

Dr. Andrew L. Fulton Kansas City, Mo. 1887 

Dr. John F. Fulton St. Paul, Minn. 1888 

Sr. Jose Gamboa, Donseles 4 Mexico, Mex. 1892 

Dr. Adrian de Garay Mexico, Mex. 1892 

Sr. Francisco de Garay Mexico, Mex. 1892 

Dr. A. Pedro Garcia Jalapa, Vera Cruz, Mex. 1892 

Dr. Crescencio Garcia Cotija, Michoacan, Mex. 1892 

Dr. LozANO iGNACio Garcl/i . S. Luis Potosi, S. Luis Potosi, Mex. 1892 

Dr. M. Garcia Mapimi, Chihuahua, Mex 1892 

Dr. PeH^a Manuel Garcia Vera Cruz, Vera Cruz, Mex. 1892 

Sr. Sanchez Facio Rafael Garcia, Camarones i . . Mexico, Mex. 1892 

Dr. Salvador Garciadiego Guadalajara, Jalisco, Mex. 1892 

Prof. James T. Gardner Albany, N. Y. 1875 

Dr. Adrian Gardu5^o Mexico, Mex. 1892 

Dr. Cantu Rafael Garza, Puente Nuevo 5, Monterey, Nuevo Leon, Mex. 1892 

Dr. Gardenas Luis de la Garza . . . Chihuahua, Chihuahua, Mex. 1892 

Dr. Francisco de la Garza Mexico, Mex. 1892 

Dr. Joseph L. Gaston Chattanooga, Tenn. 1891 

Dr. J. D. Gatch Lawrenceburg, Ind. 1876 

Dr. A. S. Gates Franklin, La. 1892 

Dr. Samuel H. Gault Rogersville, Tenn. 1891 

Dr. Franklin Gauntt Burlington, N. J. 1885 

Dr. A. GavijI^o, Ratas No. 4 Mexico, Mex. 1891 

Roberto Gayol, C. E., Cenada Santa Teresa 23 . . . Mexico, Mex. 1891 

Dr. J. P. Gayon, Jestis Maria 11 Mexico, Mex. 1892 

Dr. A. Gazano Mexico, Mex. 1892 

Dr. John B. C. Gazzo Thibodeaux, La. 1887 

Dr. H. D. Geddings, U. S. M. H. S 1889 

William Paul Gerhard, C. E., 36 Union Sq. . . New York City. 1880 

Dr. Frederic H. Gerrish Portland, Me. 1885 

Richard FiTZ Gibbon Bridgeport, Conn. 1889 

Prof. WOLCOTT GiBBS Newport, R. L 1876 

Dr. LuMAN Moody GiFFiN Boulder, Col. 1892 

Dr. Albert L. Gihon, U. S. N Washington, D. C. 1876 

Dr. Alfred C. GiRARD Fort Niagara, N. Y. 1874 

Dr. Grandison A. GOBEN Kirkesville, Mo. 1891 



322 REVISED LIST OF MEMBERS. 

Dr. John Godfrey, U. S. M. H. S New York City. 1888 

Dr. M. GoDOY Mexico, Mex. 1892 

Dr. Benito Gomez Queretaro, Queretaro, Mex. 1892 

Dr. EuGENio Z. Gomez Colima, Mex. 1892 

Dr. Gutierrez F. Gomez . . Sta. Maria del Oro, Terr. Tepic, Mex. 1892 

Dr. Juan B. Gomez Cuantitian, Mex. 1892 

Prof. Jose L. Gomez, 3 San Lorenzo St Mexico, Mex. 1890 

Dr. Amezcua J. Gonzalez S. Luis, S. Luis Potosi, Mex. 1892 

Dr. Luis G. Gonzalez Zacatecas, Zacatecas, Mex. 1892 

Dr. M. M. Gonzalez Morelia, Michoacan, Mex. 1892 

Dr. J. D. GooDPASTEUR Nashville, Tenn. 1892 

Dr. Edward C. Goodrich, 201, 202. Dyer Building . . Augusta, Ga. 1892 

Dr. R. S. Goodwin Thomaston, Conn. 1886 

Mr. Graham Toronto, Ont. 1881 

Dr. John H. Granniss Old Saybrook, Conn, 1889 

Dr. E. E. Graves Boscawen, N. H. 1886 

Mr. Crosby Gray Pittsburgh, Pa. 1874 

Henry R. Gray, 144 St. Lawrence Main Montreal, P. Q. 1886 

Dr. Mason W. Gray, 9 Saginaw St., N Pontiac, Mich. 1891 

Samuel M. Gray, C. E., \t Larch St Providence, R. L 1891 

Dr. John J. Green Pittsburgh, Pa. 1884 

Gen. CoLTON Greene Memphis, Tenn. 1880 

Dr. Walter D. Greene Buffalo, N. Y. 1890 

Dr. James G. Gregory Norwalk, Conn. 1889 

Dr. Edgerton Griffin Brantford, Ont. 1886 

Dr. John Griffin, 90 Sands St Brooklyn, N. Y. 1888 

Dr. Benjamin M. Griffith Springfield, 111. 1891 

Dr. Jefferson D. Griffith Kansas City, Mo. 1891 

Robert Griffith, 427 Clark St Chicago, 111. 1890 

Dr. William Edward Griffiths, 321 Schermerhom St. Brooklyn, N.Y. 1889 

Dr. J. C. Gronvolt Norway, Minn. 1886 

Dr. Pedro Guevara Queratara, Queratara, Mex. 1892 

Dr. Edward A. Guilbert Dubuque, Iowa. 1890 

Dr. P. J. GuiLLOT Bushkill, Pa. 1887 

Henry A. Guinzburg St. Louis, Mo. 1891 

Dr. Manuel Gutierrez, 13 AduanaVieja Mexico, Mex. 1891 

Dr. F. Gutierrez Mexico, Mex. 1892 

Dr. NufS^o Emigdio Gutierrez Guadalajara, Jalisco, Mex. 1892 

Dr. iGNACio Guzman Toluca, Mex. 1892 

Dr. Alexander Hadden, 155 £. 51st St New York City. .1889 

Hon. D. P. Hadden Memphis, Tenn. 1880 

Dr. Jacob Mover Hagey Mt. Morris, N. Y. 1892 

Dr. Frederick D. Haldeman Ord, Neb. 1891 

Dr. Junius M. Hall Chicago, 111. 1880 

Dr. Lucy M. Hall, 181 Joralemon St Brooklyn, N. Y. 1889 

W.E.Hall Kansas City, Mo. 1891 

Dr. William G. Hall St. Joseph, Mo. 1891 

Dr. George Halley, 800 Lydia Ave Kansas City, Mo. 1892 

Dr. John B. Hamilton, Sherman House Chicago, 111. 1886 

Dr. J. H. Hamilton Richford, Vt. 1891 



REVISED LIST OF MEMBERS. 323 

Dr. Samuel Newell Hamilton, 502 West Eighth St., Connorsville, Ind. 1892 

Hon. T. F. Hannon Kansas City, Mo. 1891 

Dr. Thomas J. Happel Trenton, Tenn. 1891 

Dr. R. A. Hardin Savannah, Ga. 1879 

Dr. W. S. Harding St. John, N. B. 1886 

Dr. Robert B. S. Hargis Pensacola, Fla. 1878 

Prof. Mark W. Harrington, 1909 N St. ... Washington, D. C. 1892 

Dr. Romeo Adelbert Harrington, 809 So. College St., Nashville, Tenn. 1892 

Dr. Henry Hartshorne Germantown, Pa. 1872 

Dr. W. A. Haskell Alton, 111. 1883 

Dr. Thomas Hay, 1127 Arch St Philadelphia, Pa. 1874 

Dr. Charles Addison Hayes Chippewa Fdls, Wis. 1892 

Mr. Allen Hazen Lawrence, Mass. 1892 

Dr. Arthur Hazlewood Grand Rapids, Mich. 1889 

J. M. Hazen, 15 12 Park Ave Minneapolis, Minn. 1889 

Dr. Alfred George Heaney Corpus Christi, Tex. 1892 

Rudolph Hering, C. E., 277 Pearl St New York City. 1878 

Dr. Francisco Hernandez Oaxaca, Oaxaca, Mex. 1892 

Dr. J. Hernandez Progeso, Yucatan, Mex. 1892 

Dr. Alberta Lopez Hermosa San Luis Potosi, Mex. 1892 

Dr. GoNZALO Herrara, 9 Espalda San Andres .... Mexico, Mex. 1892 

Dr. J. Herrera Mexico, Mex. 1892 

Dr. Leopoldo Herrara Mexico, Mex. 1892 

Dr. PoNCiANO Herrara Queretaro, Queretaro, Mex. 1892 

Dr. James Walter Hervey, 744 Shelby St. . . New Orleans, La. 1892 

Dr. Charles N. Hewitt Red Wing, Minn. 1872 

Dr. John B. Hibben Topeka, Kan. 1891 

Dr. James F. Hibberd Richmond, Ind. 1881 

Dr. John F. Hicks Menominee, Mich. i888 

Dr. Manuel M. Hidalgo La Paz, Baja Cal., Mex. 1892 

Hon. James D. Hill, no Caronddet St New Orleans, La. 1892 

Prof. Edward Hitchcock Amherst, Mass. 1877 

Dr. Frank £. Hitchcock, 22 White St Rockland, Me. 1892 

Dr. Albert Edward Hoadley, 683 Washington Boulevard, Chicago, 111. 1892 

Dr. Cornelius N. Hoagland, 710 Clinton Ave. . . Brooklyn, N. Y. 1887 

Dr. John U. Hobach, Union Station Baltimore, Md. 1888 

Mr. Matthew Hoelscher, iioo Carson St. ... Pittsburgh, Pa. 1892 

Herman Hollerith, 501 F St Washington, D. C. 1887 

Hon. Benjamin Holmes Kansas City, Mo. 1891 

Dr. Joseph Holt New Orleans, La. 1880 

Dr. Henry D. Holton Brattleboro, Vt. 1875 

Dr. Cooper Holtzclaw, 5 £. 9th St Chattanooga, Tenn. 1892 

Dr. George Homan, 919 Olive St St. Louis, Mo. 1879 

Dr. H. B. HORLBECK Charleston, S. C. 1880 

Hon. Albert H. Horton Topeka, Kan. 1891 

Mr. Harry E. Howell, Toronto, 28 Chester St. . . Toronto, Kan. 1891 

Dr. Henry F. Hoyt St. Paul, Minn. 1884 

Dr. E. T. Hubbard Rochester, N. H. 1892 

Dr. William H. Huger Charleston, S. C. 1890 

Dr. Charles H. Hughes, 500 N. Jefferson Ave. • . St. Louis, Mo. 1892 



324 REVISED LIST OF MEMBERS, 

Dr. Joaquin Huia, Portillo San Diego 11 J Mexico, Mex. 1892 

Hon. Lyman U. Humphrey Topeka, Kan. 1891 

Dr. A. Clark Hunt Metuchen, N. J. 1888 

Dr. C. C. Hunt Dixon, III. 1889 

Dr. Fred N. Hunt Fairmont, Minn. 1889 

Dr. Joseph H. Hunt, cor. Quincy St. and Bedford Ave., Brooklyn, N. Y. 1889 

Dr. C. H. Hunter Minneapolis, Minn. 1888 

Dr. Randall R. Hunter Kansas City, Mo. 1890 

Dr. Anson Hurd Findlay, O. 1892 

Dr. H. M. Hurd Baltimore, Md. 1883 

Dr. Francisco Hurtado Mexico, Mex. 1892 

Dr. Alexander Hutchins, 796 DeKalb Ave. . . . Brooklyn, N. Y. 1889 

Dr. Eduardo Ibarra Guanajuato, Guanajuato, Mex. 1892 

Dr. Veitia Jose Marla Ibarra, Mineral «* El Zopilote," Terr. Tepic, Mex. 1892 

Dr. Ramon Icaza, 9 Ratas St Mexico, Mex. 1891 

Dr. Jose \^\qo Mexico, Mex. 1892 

Dr. Alejandro IRIGOYEN .... Ciudad Juarez, Chihuahua, Mex. 1892 

L. E. Irwin Kansas City, Mo. 1891 

Dr. Rafael Isunza Puebla, Puebla, Mex. 1 892 

Dr. Jose Ma de Ita Puebla, Puebla, Mex. 1892 

Dr. Francisco Iturbide Morelia, Michoacan, Mex. 1892 

Dr. Gomez Luis Iturbide Morelia, Michoacan, Mex. 1892 

Dr. John W. Jackson Kansas City, Mo. 1884 

Dr. R. N. Jackson Faribault, Minn. 1889 

Dr. Samuel K. Jackson, 138 Freemason St Norfolk, Va. 1892 

Rev. D. C. JACOKES, S. T. D Pontiac, Mich. 1882 

Dr. BusHROD W. James, cor. i8th and Green Sts. . . Philadelphia, Pa. 1878 

Dr. George W. Jenkins Kilboum City, Wis. 1888 

Dr. William T. Jenkins Quarantine, Staten Island, N. Y. 1 892 

Dr. Andrew J. B. Jenner Detroit, Mich. 1883 

Dr. James W. Jenney Salina, Kansas. 1891 

Dr. L. M. DE Jesi, 21 Plaza de Armas Zacatecas, Mex. 1891 

Dr. J. Maguel JoFRE, Rebeldes 15 Mexico, Mex. 1892 

Dr. Roberto Jofre, Rebddes 15 Mexico, Mex. 1892 

Dr. Wyatt Johnson, St. James Qub Montreal, Can. 1892 

Dr. George H. T. Johnson Atchison, Kan. 1891 

Dr. Sam C. Johnson Hudson, Wis. 1883 

Dr. Wirt Johnston Jackson, Miss. 1878 

Dr. D. C. Jones Topeka, Kan. 1887 

Dr. George Wheeler Jones, 209 North St Danville, 111. 1892 

Dr. H. Isaac Jones, 118 Grant Ave San Francisco, Cal. 1880 

Dr. J. W. Jones Tarborough, N. C. 1885 

Dr. Leander P. Jones Greenwich, Conn. 1889 

Dr. Leonides E. Jonguitud Tenandngo, Mex. 1892 

Edward C. JoiDAN, C. E Portland, Me. 1886 

Dr. Herbert J UDD, 104 Main St Galesburg, III. 1892 

Dr. Francisco Kaska Mexico, Mex. 1892 

Hon. J. M. Keating Memphis, Tenn. 1880 

Dr. Robert C. Kedzie Lansing, Mich. 1873 

Dr. J. H. Kellogg Battle Creek, Mich. 1878 



REVISED LIST OF MEMBERS. 32$ 

George T. Kemp, Ph. D., 173 Joralemon St. . . . Brooklyn, N. Y. 1889 

Dr. G. W. H. Kemper, 116 W. Adams St Muncie, Ind. 1892 

Dr. J. F. Kennedy Des Moines, Iowa. 1885 

Dr. Isaac N. Kerlin Elwyn, Pa. 1874 

Dr. G. M. Kimball Concord, N. H. 1886 

Dr. James P. Kimball, U. S. A Santa F6, N. M. 1892 

Mr. Branch M. King, 214 Gaines St New Orleans, La. 1892 

Dr. Charles F. King Hudson, Wis. 1888 

Dr. Byron F. Kingsley, cor. Elm and Starr , . . San Antonio, Tex. 1892 

Dr. S. P. B. Knox, A. M., 912 Anacapa .... Santa Barbara, Cal. 1892 

Dr. William F. Knox McKeesport, Pa. 1887 

Dr. Cornelius Kollock Cheraw, S. C. 1884 

Dr. William Krauss Memphis, Tenn. 1891 

Emil Kuichling, C. E Rochester, N. Y. 1882 

Dr. Julian Kuiz Zacatecas, Mex. 1892 

Dr. Louis Laberge Montreal, P. Q. 1886 

Dr. Emmanuel P. Lachapelle Montreal, P. Q. 1887 

Dr. £. Lamadrid Puebla, Puebla, Mex. 1892 

Dr. Eduardo Lamig, 2* Mesones 22 Mexico, Mex. 1892 

Dr. Robert A. Lancaster Gainesville, Fla. 1892 

Dr. Jesus T. Larios Guadalajara, Jalisco, Mex. 1892 

Dr. Moses Croft Lathrop, 16 St. John St Dover, N. H. 1892 

Dr. S. W. Latta Trenton, N. J. 1885 

Dr. Rafale Lavista Mexico, Mex. . 1892 

Prof. James Law Ithica, N. Y. 1872 

Dr. Archibald Lawson, Patoni 5 Mexico, Mex. 1892 

Dr. M. M. Leahy, 6648 Wentworth Ave Chicago, 111. 1892 

Dr. Francisca de P. Leal, San Andres 17 Mexico, Mex. 1892 

Dr. John Lainy Leal, 149 Ellison St Paterson, N. J. 1891 

Dr. Benjamin Lee, 1522 Pine St Philadelphia, Pa. 1874 

Dr. LuciAN Lavassa Leeds, 513 Broadway Lincoln, 111. 1892 

L. Z. Leiter, Esq., P. O. Drawer L Chicago, 111. 1876 

William T. Lemp St. Louis, Mo. 1884 

Dr. B. B. Lenoir Lenoir's, Tenn. 1879 

J. H. Letcher Henderson, Ky. 1892 

Hon. William P. Lethworth .... Glen Iris, Portageville, N. Y. 1874 

Dr. John B. Learned Florence, Mass. 1889 

Dr. Charles Lehlbach, 225 Washington St. . . . Newark, N. J. 1892 

Dr. L. Leon Morelia, Michoacan, Mex. 1892 

Wallace G. Levison, 317 Livingston St Brooklyn, N. Y. 1889 

Dr. Philip W. Lewellyn Clarinda, Iowa. 1890 

Dr. George W. Lewis, 5 Bourbon St New Orleans, La. 1892 

Dr. Henry M. Lewis, 171 Remsen St Brooklyn, N. Y. 1889 

Dr. James R. Lewis Grinnell, Iowa. 1892 

Dr. Richard H. Lewis * . Raleigh, N. C. 1892 

Dr. H. H. Levy Richmond, Va. 1878 

Dr. Eugene R. Lewis Kansas City, Mo. 1884 

Dr. Francis W. Lewis, 2016 Spruce St Philadelphia, Pa. 1874 

Dr. Eduardo Lic£aga, 4 San Andres St Mexico, Mex. 1891 

Dr. E. LiER Mexico, Mex. 1892 



326 REVISED LIST OF MEMBERS. 

Dr. Salvador Ubgas Limon, Bucarely i Mexico, Mex. 

Dr. Charles A. Lindsley New Haven, Conn 

Dr. J. Berrien Lindsley Nashville, Tenn 

Dr. J. M. Lindsley Nashville, Tenn 

Dr. John B. Linehan, 301 Mott St New Yoric City. 

Dr. Nazario Lomas, 3 Hildago St. . • • Cuemavaca, Morelos, Mex. 
Capt. Oscar F. Long, U. S. Army, Washington, D. C, care of War Dep't 

Dr. B. Jose Lopez Campeche, Campeche, Mex 

Dr. Fernando Lopez Mexico, Mex 

Dr. Garcia Francisco Lopez Merida, Yucatan, Mex. 

Dr. Hermosa A. Lopez S. Luis Potosi, Mex 

Dr. Rafael Lopez Mexico, Mex 

James L. Loring, C. £ Dallas Centre, Iowa 

Dr. Juan W. C. Love Mexico, Mex. 

Harvey C. Lowrie, C. E Denver, Col 

Sr. Ortega Victor y Lucio, Estampa, San Andres 13 . Mexico, Mex. 

Jacob Lott Ludlow, C. E Winston, N. C 

Dr. Hidalgo J. M. Lugo Mexico, Mex 

Dr ViNAS Jose Lugo Tlalnepantla, Mex 

Dr. W. J. LuMSDEN Elizabeth City. N, C. 

Prof. Fernado Luna y Drucina, Botica de Ortega . . . Mexico, Mex 

Alan Mcdougall, C. E Toronto, Ont 

Dr. A. Macias Guanajuato, Guanajuato, Mex, 

Dr. Charles Griffith Worthington Macgill . . CantonsviUe, Md 

Dr. Hugh W. Mackay Woodstock, Ont. 

William S. MacHarg, C. E., 14 Pacific Ave Chicago, 111. 

Dr. James H. Maddox Strafford, Miss 

Dr. Ramon MagaH^a '. Morelia, Michoacan, Mex 

Dr. Annibal Maguire Jeannette, La. 

Dr. M. Maicot Mexico, Mex. 

Dr. Fernando Malanco Mexico, Mex. 

Dr. G. E. Manigault Charleston, S. C 

Dr. Francisco Marin Puebla, Puebla, Mex. 

Dr. Jose Marin Puebla, Mex, 

Dr. Lucas Marin Compostda, Terr. Tepic, Mex 

Dr. Solon Marks Milwaukee, Wis 

Dr. Francisco Marmolejo Guanajuato, Mex. 

Dr. Albert Marois, 51 St. Louis St Quebec, P. Q 

Dr. E. J. Marsh Paterson, N. J 

Edward F. Martin, 301 Mott St New York City 

Dr. Robert Martin Milwaukee, Wis 

Dr. Alfonzo Martinez Monterey, Nuevo Leon, Mex 

Dr. AusTACio Martinez, i» Santisimia 7 Mexico, Mex 

Dr. Baca Francisco Martinez PuebJa, Puebla, Mex. 

Dr. Calleja Franco Martinez . Ciudad Victoria, Tamaulipas, Mex 

Dr. Enrique Martinez Apatzingan, Michoacan, Mex 

Charles D. Marx, C. E., Leland Stanford, Jr., University, Palo Alto, Cal 

Dr. Miguel Marquez Chihuahua, Chihuahua, Mex 

Dr. N. H. Matas, 12, 3d Independencia St Mexico, Mex 

Dr. A. Matienzo Tampico, Tamaulipas, Mex. 



1892 
1875 
1877 
1879 
1889 
1 891 
1892 
1892 
1892 
1892 
1892 
1892 
1890 
1892 
1886 
1892 
1 891 
1892 
1892 
1892 
1892 
1886 
1892 
1892 
1889 
1889 
1887 
1892 
1892 
1892 
1892 
1890 
1891 
1892 
1892 
1876 
1892 
1889 
1872 
1889 
1885 
1892 
1892 
1892 
1892 
1892 
1886 
1892 
1892 
1892 



REVISED LIST OF MEMBERS, 327 

Dr. H. Matthey, cor. 2d and Harrison Sts Davenport, Iowa. 1892 

Dr. George T. Maxwell Jacksonville, Fla. 1889 

Dr. Mexcio Maycot, !• Guerrero 16 Mexico, Mex. 1892 

Dr. Frederic J. Mayor Lafayette, La. 1892 

Dr. Hugh McCall Lapeer, Mich. 1892 

Dr. John D. McCleary Indianola, Iowa. 1892 

Dr. Ezra S. McClellan Paterson, N. J. 1889 

Dr. J. H. McClelland . Pittsburgh, Pa. 1885 

Dr. J. H. McCoLLOM, 57 Dwight St Boston, Mass. 1884 

Dr. Johnson G. McCollough, 44 Noble St Bellaire, Ohio. 1892 

Dr. Joslah Lee McComas Oakland, Md. 1892 

Dr. J. N. McCormack Bowling Green, Ky. 1880 

Dr. John R. McCullouoh, 37 Park Ave Chicago, 111. 1892 

Dr. Wilford Ward McDaniel Granger, Tex. 1892 

Dr. John R. McDill Milwaukee, Wis. 1888 

Dr. Calvin D. McDonald Kansas City, Mo. 1889 

C. G. W. McGiLL Cantonsville, Md. 1892 

Dr. W. Page McIntosh, U. S. M. H. S San Francisco, Cal. 1885 

Dr. McKeoun Toronto, Ont. 1891 

W. P. McLaren. Esq Milwaukee. Wis. 1888 

Dr. James W. McLaughlin, 800 San Antonio St. . . . Austin, Tex. 1892 

Dr. John T. McLean Alameda, Cal. 1889 

Hon. Albert L. McNeal Bolivar, Tenn. 1879 

I. C. McNeill. 1315 E. 22d St Kansas City, Mo. 1891 

Dr. James Francis McShane, 2 So. Patterson Park Ave., Baltimore, Md. 1892 

Mr. Daniel Webster Mead. 1102 S. Main St Rockford, 111. 1892 

Dr. Manuel T. Meana Guanajuato, Mex. 1892 

Dr. John Mears, 28 and 30 Times Building .... Kansas City, Mo. 1891 

Dr. Demetrio ^VIejia Mexico, Mex. 1892 

Dr. Miguel Mejia S. Luis Potosi, S. Luis Potosi, Mex. 1892 

Dr. Allard Memminger Charleston, S. C. 1890 

Dr. Manuel M. Mena Puebla, Puebla, Mex. 1892 

Dr. Gregorio Mendizabal, 2 S. Miguel St. . Orizaba, Vera Cniz, Mex. 1891 

Dr. Fernandez Ismael Mendoza, 2* Rdox 6 . . . . Mexico, Mex. 1892 

Dr. Lopez M. Mendoza, Merced 69 . . . Guadalajara, Jalisco, Mex. 1892 

Dr. G. W. Menees Springfield, Tenn. 1891 

Dr. Alfred Mercer Syracuse, N. Y. 1886 

Hon. George A. Mercer Savannah, Ga. 1881 

Dr. Luis Merino Guadalajara, Jalisco, Mex. 1892 

Dr. Albert Merrell, 3814 Washington Ave. ... St. Louis, Mo. 1891 

Dr. A. K. P. Meserve Portland, Me. 1892 

Dr. Charles N. Metcalf Indianapolis, Ind. 1885 

Henry C Meyer, C. E New York City. 1882 

Dr. Middleton Michel Charleston, S. C. 1890 

Dr. Edwin Middlebrook, ioio Grand Ave Kansas City, Mo. 1891 

Dr. Fernando Mier Saltillo, Coahuila, Mex. 1892 

Dr. Edson Carey Miller Rockwell, Iowa. 1892 

Mr. Harry East Miller, Ph. D., 1264 14th St. . . . Oakland, Cal. 1892 

Dr. Katharine Miller, 513 Broadway Lincoln, 111. 1892 

Dr. Samuel Edwin Milliken, 157 Msidison Ave. . . New York City. 1892 



328 REVISED LIST OF MEMBERS. 

Andrew S. Mitchell Milwaukee, Wis. 1888 

Dr. Charles Mitchell Nashville, Term. 1884 

Dr. Henry Mitchell Asbury Park, N. J. 1886 

Dr. Jesse B. Mitchell Datura, Tenn. 1891 

Dr. R. W. Mitchell Memphis, Tenn. 1878 

Dr. William Francis Mitchell Lancaster, Mo. 1892 

Dr. AuGUSTO Molina Merida, Yucatan, Mex. 1892 

Dr. D. MOLINAR Parral, Chihuahua, Mex. 1892 

Dr. George Newman Monette, 5 Paytania St. . . New Orleans, La. 1892 

Dr. Jesus E. Monjaras, Cino de Mayo . . . San Luis Potosi, Mex. 1891 

C. MONJEAU Cincinnati, Ohio. 1887 

Dr. Antonio Monroy . . . S. Miguel de Allende, Guanajuato, Mex. 1892 

Dr. E. MoNSiVAis S. Luis Potosi, S. Luis Potosi, Mex. 1892 

Dr. Emilio a. MontaS^o, San Hipolito 20 Mexico, Mex. 1892 

Dr. F. Monta5^o Mexico, Mex. 1892 

Dr. Enrique Montero Oaxaca, Oaxaca, Mex. 1892 

Dr. L. H. Montgomery Chicago, 111. 1879 

Dr. Frederick Montizambert Grosse Isle, Quebec, P. Q. 1885 

Dr. Edward Mott Moore, 74 So. Fitzhugh St. . . Rochester, N. Y. 1892 

Robert Moore, C. E St. Louis, Mo. 1880 

Dr. Emma W. Mooers Arlington, Mass. 1888 

Dr. Alberto Moreno Puebla, Puebla, Mex. 1892 

Dr. EuGENio Moreno Lagos, Jalisco, Mex. 1892 

Dr. Jose Donaciano Morales, Hospicio San Nicoles 13 . Mexico, Mex. 1892 

Dr. Jose Joaquin Morales Mexico, Mex. 1892 

Dr. Pereira Samuel Morales Mexico, Mex. 1892 

David Percy Morgan, 106 E. 37th St New York City. 1885 

Dr. John Morris Baltimore, Md. 1874 

Dr. J. Cheston Morris, 15 14 Spruce St Philadelphia, Pa. 1883 

Dr. Prince A. Morrow, 66 W. 40th St New York City. 1889 

William F. Morse, S. E., 30 State St New York City. 1889 

Dr. Eliza M. Mosher, 181 Joralemon St Brooklyn, N. Y. 1889 

Dr. M. Mucel Mexico, Mex. 1892 

Dr. Alexander J. Mullen, Jr., 409 Washington St., Michigan City, Ind. 1892 

Dr. Byron Wooster Munson Sharon, Conn. 1889 

Dr. J. B. Murfree Murfreesboro, Tenn. 1891 

Alexander W. Murray, 811 W. Madison St ... • Chicago, 111. 1884 

Dr. Robert D. Murray, U. S. M. H. S. .... Key West, Fla. 1872 

Dr. R. D. MussEY Glendale, Ohio. 1889 

Dr. John T. Nagle, 301 Mott St New York City. 1874 

Dr. M. Narro, Tarasquillo 10 Mexico, Mex. 1892 

Dr. Florencio Narvaez Merida, Yucatan, Mex. 1892 

Dr. A. Nash Joliet. 111. 1887 

Dr. Herbert M. Nash Norfolk, Va. 1878 

Dr. Manuel Nava Puebla, Puebla, Mex. 1892 

Dr. E. A. Neeley, 126 Hernando St Memphis, Tenn. 1891 

Dr. Stewart Maurice Neff Chattanooga, Tenn. 1892 

Dr. M. V. B. Newcomer Tipton, Ind. 1892 

Dr. William K. Newton Paterson, N. J. 1883 

Dr. Orombello G. Nibbi Mexico, Mex. 1892 



REVISED LIST OF MEMBERS, 329 

Dr. Frank P. Norbury Jacksonville, 111. 1889 

Dr. Alberto Noriega HermosiUo, Sonora, Mex. 1891 

Dr. Pedro Noriega, 83 Dr. Mier St. . . Monterey, Neuvo Leon, Mex. 1891 

Dr. Tomas Noriega, Hospital de Jesus Mexico, Mex. 1892 

Dr. Enrique Novelo Campeche, Campeche, Mex. 1892 

Dr. Joshua Copp Noyes, 65 Washington St. ..... Oshkosh, Wis. 1892 

Dr. Tobias Nunez, 2* Del. Factor 8 Mexico, Mex. 1892 

Dr. R. J. NuNN Savannah, Ga. 1881 

Dr. George H. F. Nuttall Baltimore, Md. 1891 

Dr. Lauro Obregon Mexico, Mex. 1892 

Dr. M. O'Brien Topeka, Kan. 1891 

Dr. L. OcAMPO, Puerta Falso de Santo Domingo 4 . . . Mexico, Mex. 1892 

Dr. R. OcHOA Jalapa, Vera Cruz, Mex. 1892 

Dr. M. C. O'Connor New Haven, Conn. 1888 

Dr. D. W. Odell Freeport, Kan. 1892 

Mr. S. Odenheimer New Orleans, La. 1892 

Dr. Alberto O'Farrill Puebla, Puebla, Mex. 1892 

Dr. Gustavo O'Farrill Puebla, Puebla, Mex. 1892 

Dr. Charles Robert Oglesby Pensacola, Fla. 1892 

Dr. William Oldright Toronto, Ont. 1883 

Dr. Samuel Rutherford Olliphant, hi Prytania St, New Orleans, La. 1892 

Dr. Jesus O^ate, Mexico, Mex. 1892 

Dr. H. S. Orme Los Angeles, CaL 1885 

Ingerniro Ricardo Orozco, San Andres 17 .... Mexico, Mex. 1892 

Dr. Ricardo Orozco, Rinconada, San Francisco 5 . . Irapuato, Mex. 1892 

Mr. Geo. H. Orr, Health Dept., 9 Toronto St. ... Toronto, Can. 1892 

Dr. Francisco Ortega, San Pedro y San Pablo 9 . . . Mexico, Mex. 1892 

Dr. Jose de Jesus Ortega . . . S. Juan de los Llanos, Puebla, Mex. 1892 

Sr. Orozco Ricardo Ortega Mexico, Mex. 1892 

Dr. Reyes Manuel Ortega, 4* Cipr6s 9 Mexico, Mex. 1892 

Dr. A. Ortiz Alamos, Sonora, Mex. 1892 

Dr. Cordova Ignacio y Ortiz, Huerto 74 . Guadalajara, Jalisco, Mex. 1892 

Dr. John G. Orton Binghamton, N. Y. 1890 

Dr. Domingo OrvaIJ^anos, 25 Chavarria St Mexico, Mex. 1890 

Michael J. O'Shaughnessy Huntsville, Ala. 1879 

Dr. Jose D. Osorio Texcoco, Mexico, Mex. 1892 

Dr. Miguel Otero, Hospital Militar, S. Luis Potosi, St Luis Potosi, Mex. 1892 

Dr. William C. Otterson, 144 Pierrepont St. . . . Brooklyn, N. Y. 1887 

F. N. Owen, C. E.. 13 William St New York City. 1883 

Dr. Jesse Mercer Pace, 350 Young St Dallas, Tex. 1892 

Dr. Frank K. Paddock Pittsfield, Mass. 1889 

Dr. Enrique Palazuelos Tampico, Tamaulipas, Mex. 1892 

Dr. Charles Newell Palmer, 131 Locust St. . . . Lockport, N. Y. 1892 

Dr. Friend Palmer Cevrillos, N. M. 1892 

Dr. M. Palomino Merida, Yucatan, Mex. 1892 

Dr. A. H. Paquet St. Cuthbert, P. Q. 1889 

Dr. Paul Paquin, D. V. S Lebanon, Mo. 1891 

Dr. Frederick William Parham New Orleans, La. 1892 

Dr. James Monroe Parker Mt. Pleasant, la. 1892 

Dr. G. Parra, Guadalupe 125, Tacubaya Mexico. 1892 



330 REVISED LIST OF MEMBERS. 

Dr. Joaquin Parres Guanajuato, Guanajuato, Mex. 1892 

Dr. J. M. Partridge South Bend, Ind. 1881 

Dr. Francisco Paschal Chihuahua, Chihuahua, Mex. 1892 

Dr. C. R. Patino Mexico, Mex, 1892 

Dr. Frank P. Peck Mt. Pleasant, la. 1892 

Dr. George Peck, U. S. Navy, 926 N. Broad St. . . Elizabeth, N. J. 1890 

Dr. OziAS W. Peck Oneonta, N. Y. 1887 

Dr. C. T. Peckham, U. S. M. H. S St. Louis, Mo. 1887 

Dr. £lz£ar Pelletier Montreal, P. Q. 1892 

Henry E. Pellew, Esq Katonah, N. Y. 1876 

Dr. J. W. Penn Humboldt, Tenn. 1891 

Dr. Alfaro Leon Pena Mexico, Mex. 1892 

Dr. Contreras Jose Peon Mexico, Mex. 1892 

Dr. Genaro Perez Mexico, Mex. 1892 

Dr. Gil A. Perez Morelia, Michoacan, Mex. 1892 

Dr. M. Perez Mexico, Mex. 1892 

Dr. Salazar Augustin Perez Puebla, Puebla, Mex. 1892 

Dr. Maurice Perkins Schenectady, N. Y. 1888 

Dr. Michael Perl, 520 Travis St Houston, Tex. 1892 

Dr. E. Pesqueira Hacienda de la Misa, Sonora, Mex. 1892 

Dr. N. J. Pettijohn Kansas City, Mo. 1891 

Dr. D. L. Phares Agricultural College, Miss. 1880 

Dr. Hugo Philler Waukesha, Wis. 1888 

Dr. Ellis Phillips New Haven, Penn. 1892 

Dr. J. H. Phillips Preston, Minn. 1890 

Hon. Edwin L. Pillsbury, 12 Beacon St Boston, Mass. 1889 

Dr. Edward Playter Ottawa, Ont. 1886 

Dr. Richard Henry Plummer, 625 Mission St. • San Francisco, Cal. 1892 

Dr. Samuel C. Pluhmer Rock Lsland, 111. 1888 

Dr. J. D. Plunket Nashville, Tenn. 1878 

Dr. L. PoLA Mexico, Mex. 1892 

Dr. D. PoLi Mexico, Mex. 1892 

Dr. V. PoLi Mexico, Mex. 1892 

Dr. Emilio Polo Puebla, Puebla, Mex. 1892 

Miss Emma C. G. Polson New Haven, Conn. 1888 

Dr. Joseph Y. Porter. U. S. A Key West, Fla. 1878 

Dr. Thomas K. Powell Dancyville, Tenn. 1879 

Dr. Thomas Powell, 762 Judson St . Fort Scott, Kan. 1891 

Dr. R. N. Prado, Sepulcros, Santo Domingo 6 . . . . Mexico, Mex. 1892 

Dr. C. PRECIADO Mexico, Mex. 1892 

Dr. J. W. Prendergast Cincinnati, Ohio. 1890 

Dr. Silas Dean Presby, 103 Weu- St Taunton, Mass. 1892 

Dr. Charles W. Preston, 570 Leonard St. ... Brooklyn, N. Y. 1888 

Dr. J. Mallet Prevost Zacatecas, Mex. 1892 

Dr. ISMAEL Prieto, 12* Violeta6i2 Mexico, Mex. 1892 

Dr. Parra Jose Prieto Chihuahua, Chihuahua, Mex. 1892 

Dr. C. O. Probst Columbus, Ohio. 1886 

Dr. Juan Puerto, Tuleta 4 Mexico, Mex. 1892 

Mr. JosiAH C. PuMPELLY, I East 39th St New York City. 1892 

Hon. George T. Putnam Kansas City, Mo. 1891 



REVISED LIST OF MEMBERS. 33I 

Dr. Francis Rae Oshawa, Out. 1886 

Dr. George G. Rahausbr, 2519 Carson St. ... Pittsburgh, Pa. 1892 

Dr. J. B. Ralph Omaha, Neb. 1889 

Dr. Arellano Juan de Ramirez, Chiconanda, 24 . . . Mexico, Mex. 1892 

Dr. Arellano Juan Jose de Ramirez, i* de Spto.3 . . Mexico, Mex. 1892 

Dr. Arellano Nicolas Ramirez, Medinas 1 1 . . . . Mexico, Mex. 1892 

Dr. Jose Ramirez, Plazuela Buena Vista 1626 . . . . Mexico, Mex. 1892 

Sr. Jacobo Ramiro, Cabzada Santa Marie la Redona 37 . Mexico, Mex. 1892 

Dr. Jose Ramos S. Luis Potosi, S. Luis Potosi, Mex. 1892 

John E. Randall Memphis, Tenn. 1887 

Dr. Angel Rangel Puebla, Puebla, Mex. 1892 

Dr. Robert C. Rasin, 211 West Franklin St. . . . Baltimore, Md. 1892 

Dr. William C. Ravenel Charleston, S. C. 1890 

Dr. Allen A. Rawson Corning, Iowa. 1892 

Dr. Joseph H. Raymond, 173 Joralemon St. ... Brooklyn, N. Y. 1882 

Dr. Madison Reece Abingdon, 111. 1892 

Dr. Charles A. Lee Reed, 311 Elm St Gndnnati, Ohio. 1892 

Hon. Harrison Reed Jacksonville, Fla. 1888 

Dr. J. T. Reeve Appleton, Wis. 1876 

Dr. James £. Reeves Chattanooga, Tenn. 1872 

Dr. Edward A. Reiley, 312 Baldwin St Elmira, N. Y. 1890 

Dr. Peter Charles Remondino, cor. F and Sixth Sts. San Diego, Cal. 1890 

Dr. J. C. Rendon Merida, Yucatan, Mex. 1892 

Dr. Romulo M. Rendon Jalapa, Vera Cruz, Mex. 1892 

Dr. Juan N. Revueltas Tepic, Terr. Tepic, Mex. 1892 

Dr. R. Revilla Mexico, Mex. 1892 

Dr. Agustin Reyes Mexico, Mex. 1892 

Dr. E. Reyes Tlalnepantla. Mex. 1892 

Dr. Albert Reynolds, 416, 6th Ave Clinton, Iowa. 1892 

Dr. Ephraim M. Reynolds Centreville, Iowa. 1890 

Dr. James Degnan Reynolds, 506 Mon^omeiy St. . Creston, Iowa. 1892 

Dr. Agustin Reza, Hospicio de San Nicolas 15 . . . . Mexico, Mex. 1892 

Dr. Albert R. Rice Springfield, Mass. 1884 

Mrs. E. H. Richards, Institute Technology .... Boston, Mass. 1888 

C. L. Richards Davenport, Iowa. 1887 

Edgar Richards, 1621 H St Washington, D. C. 1889 

Dr. C. T. Richardson Charleston, W. Va. 1881 

Dr. DwiGHT A. Richardson . Shelton, Conn. 1885 

Maj. Henry B. Richardson, C. E New Orleans, La. 1880 

Dr. W. L. Richardson, 225 Commonwealth Ave. . . Boston, Mass. 1875 

Dr. J. M. Ridge Kansas City, Mo. 1891 

Dr. John A. RiGDEN What Cheer, Iowa. 1892 

Dr. LozA Maximino DE LA Rio Mexico, Mex. 1892 

Dr. Narciso DEL Rio Vera Cruz, Mex. 1892 

Dr. Isaac Rivas, 1509 Washington St San Francisco, Cal. 1892 

Dr. William C. Rives, 113 E. 38th St New York City. 1885 

Dr. Charles F. Roberts, 69 E. 54th St New York City. 1892 

Dr. John B. Roberts, 1627 Walnut St Philadelphia, Pa. 1886 

Dr. William Pinckney Roberts, i N. Madison . . Evansville, Wis. 1891 

James S. Robinson Memphis, Tenn. 1887 



332 REVISED LIST OF MEMBERS, 

Prof. Franklin C. Robinson Brunswick, Me. 1889 

Dr. Francisco Robles Guanajuato, Guanajuato, Mex. 1892 

Dr. E. Rodriguez Monterey, Nuevo Leon, Mex. 1892 

Dr. Prudencio V. Rodriguez Mulege, Baja Cal., Mex. 1892 

Dr. Pablo Rojas AtotonUco, Talisco, Mex. 1892 

Dr. Felipe Ronquillo . Jimenez, Chihuahua, Mex. 1892 

Dr. Antonio Romero, i* Mesonesi 8 Mexico, Mex. 1892 

Dr. Sotero Romero, Quezadas 10 Mexico, Mex. 1892 

Dr. Francis J. Rogers Stamford, Conn. 1889 

Dr. S. A. Rogers Memphis, Tenn. 1891 

Dr. George H. Roh]& Baltimore. Md. 1880 

Dr. Henry W. Rose Westerly, R. I. 1886 

Dr. Ross B. Rowe Reading, Pa. 1888 

J. B. RoziER Memphis, Tenn. 1887 

Dr. iGNACio Rubio Guanajuato, Guanajuato, Mex. 1892 

Dr. Enrique Rueda Puebla, Puebla, Mex. 1892 

Dr. Charles Augustus Ruggles, 465 California St. . Stockton, Cal. 1892 

Dr. Antonio M. Ruiz Texcoco, Mex. 1892 

Dr. Edozain Alfonso Ruiz Mexico, Mex. 1892 

Dr. Julian Ruiz Zacatecas, Zacat^cas, Mex. 1892 

Dr. Luis E. Ruiz Cuemavaca, Morelos, Mex. 1892 

Dr. Ramon Ruiz Salvatierra, Guanajuato, Mex. 1892 

Dr. Julia Wallace Russell, 44 Pleasant St. . . . Concord, N. H. 1892 

Dr. Thomas P. Russell Oshkosh, Wis. i888 

Dr. R. Rutherford Houston, Tex. 1879 

Dr. John S. Ryburn Ottawa, 111. 1892 

Dr. J. RiCARDO Sainz Merida, Yucatan, Mex. 1892 

Dr. IsMAEL Salas S. Luis Potosi, S. Luis Potosi, Mex, 1892 

Dr. M. A. Salas Puebla, Puebla, Mex. 1892 

Dr. Pedro Jose Salicrup, 129 E. 17th St New York City. 1892 

Dr. Antonio Salinas y Carbo, Santa Isabel 11 i . . . Mexico, Mex. 1892 

Dr. Levi B. Salmams Guanajuato, Guanajuato, Mex. 1892 

D. E. Salmon, D. V. M Washington, D. C. 1883 

Dr. LuciEN F. Salomon New Orleans, La. 1879 

Dr. Jose A. Samaniego Ciudad Juarez, Chihuahua, Mex. 1892 

Dr. M. Samanie Ciudad Juarez, Chihuahua, Mex. 1892 

Dr. Francisco Sanchez Puebla, Puebla, Mex. 1892 

Dr. J. DE J. Sanchez, 2* Salto del Agua i Mexico, Mex. 1892 

Prof. J. Leonard Sanford New Haven, Conn. 1885 

Prof. D. A. Sargent Cambridge, Mass. 1883 

Dr. Wilbur T. Sarles Sparta, Wis. 1888 

Dr. R. Sarmiento, Calle de Iturbide 622 Mexico, Mex. 1892 

Dr. Adolph F. Saurehering Mayville, Wis. 1888 

Dr. D. D. Saunders Memphis. Tenn. 1879 

Dr. N. J. Sawyier Frankfort, Ky. 1879 

Dr. Edward W. Schauffler, 1221 Washington St. . Kansas City, Mo. 1891 

Dr. W. L. Schenck Topeka, Kan. 1891 

Dr. W. S. Scott Dickson, Tenn. 1891 

Dr. John H. Sears Waco, Tex. 1887 

Mr. W. F. Sebert, 333 Clinton St. ...... Brooklyn, N. Y. 1892 



I 



REVISED LIST OF MEMBERS. 333 

Dr. William Seguine Rosebank, N. Y. 1892 

Dr. Robert Selden Catskill, N. Y. 1892 

Dr. GuiLLERMO Senisson, 2* Aduana Viljo 10 ... . Mexico, Mex. 1892 

Dr. Nicholas Senn Chicago, 111. 1888 

Dr. Manuel Septien Queretaro, Queretaro, Mex. 1892 

Dr. Rafael Serrano Puebla. Puebla, Mex. 1892 

Dr. J. C. Shapard Winchester, Tenn. 1891 

Dr. Joseph Sharp, 1027 Cherry St. ...... Kansas City, Mo. 1891 

Dr. William Kelso Sheddan Williamsport, Tenn. 1892 

Dr. Charles H, Shepard, 81 Columbia Heights . . Brooklyn, N. Y. 1889 

Dr. J. L. Shepard Sheboygan Falls, Wis. 1888 

Dr. George R. Shepherd Hartford, Conn. 1886 

Dr. George W. Sheppard Atlantic City, N. J. 1889 

Dr. B. Franklin Sherman Ogdensburg, N. Y. 1887 

Dr. John J. Sherman Marinette, Wis. 1888 

Dr. G. M. Shillito, Roup St Pittsburgh, Pa. 1892 

Dr. William H. Shipps Bordentown, N. J. 1889 

Dr. William H. Short, cor. Detroit and Central Ave., La Grange, Ind. 1892 

Dr. John C. Shrader Iowa City, Iowa. 1890 

Dr. John D. Shull Hightstown, N. J. 1888 

Sr. Feux de la Sierra Toluca, Mex. 1892 

Dr. M. O. SiLVA S. Luis Potosi, S. Luis Potosi, Mex. 1892 

Dr. F. L. SIMM Memphis, Tenn. 1885 

Dr. T. Grange Simons Charleston, S. C. 1881 

Dr. James Simpson San Francisco, Cal. 1886 

Dr. Maxwell G. Simpson Jersey City, N. J. 1889 

Dr. C. M. Sitman Greensburg, La. 1878 

Dr. John O. Skinner, U. S. A Marathon, Tex. 1892 

Dr. Jacob L. Slager Paulding, Ohio. 1892 

Dr. W. K. Sloan, 1032 sth Ave Moline, 111. 1892 

Charles E. Slocum, Ph. D Defiance, Ohio. 1892 

Dr. Charles Smart, U. S. A Washington, D. C. 1882 

Samuel M. Smedley, C. E Philadelphia, Pa. 1874 

Dr. Charles D. Smith Portland, Me. 1885 

Dr. Charles Magill Smith Franklin, La. 1892 

Dr. David S. Smith, 1255 Michigan Ave Chicago, III. 1880 

Dr. Hugh M. Smith, 78 Orange St Brooklyn, N. Y. 1889 

Dr. Joel W. Smith Charles City, Iowa. 1888 

Dr. Joseph R. Smith, U. S. A Los Angeles, Cal. 1874 

Roland H. Smith, M. E Pittsburg, Pa. 1887 

Rev. Samuel G. Smith, D. D St. Paul, Minn. 1889 

Dr. Stephen Smith, 574 Madison Ave New York City. 1872 

Dr. Theobald Smith Washington, D. C. 1888 

Gen. W. J. Smith Memphis, Tenn. 1878 

Dr. WiLLLAM M. Smith, 91 First PI Brooklyn, N. Y. 1880 

Dr. Whitmore Sniverly Pittsburgh, Pa. 1873 

Frank H. Snow Lawrence, Kan. 1891 

Dr. H. Solares, Arsines 13 Mexico, Mex. 1892 

Dr. Andrew B. SoMERS Omaha, Neb. 1888 

Dr. Walter B. Sommerville, 209 Delachier St. . . New Orleans, La. 1892 



334 REVISED LIST OF MEMBERS. 

Dr. Benito Soriano, 1718 Puenta Blanca Mexico, Mex. 1892 

Dr. S. B. Sperry Delafield, Wis. 1888 

Dr. Joseph Spiegelhalter, 2166 La&yette Ave. . . St. Louis, Mo. 1880 

John Spirked, D. D. S., 287 W. 12th St Chicago, III. 1892 

Dr. John Victor Spring, 277 Commerce St. . . San Antonio, Tex. 1892 

Prof. J. M. Stalker, D. V. S. . . . ; Ames, Iowa. 1890 

Dr. Grant Francisco Starkey, V. S Boone, Iowa. 1891 

Dr. Byron Stanton Cincinnati, Ohio. 1889 

Dr. Franklin Staples Winona, Minn. 1885 

Dr. Ralph £. Starkweather, Dearborn and Wash^n Sts., Chicago, 111. 1879 

Surgeon-General George M. Sternberg, U. S. A., Washington, D. C. 1874 

Dr. James A. Steuart Baltimore, Md. 1874 

Dr. Eugene F. Storke Milwaukee, Wis. 1888 

Dr. Shelden Stringer Brooksville, Fla. . 1892 

Dr. John C. Sundberg, 1819 Clay St San Francisco, Cal. 1892 

Dr. Charles Sutherland, U. S. A Washington, D. C. 1889 

Dr. W. R. D. Sutherland Winnipeg, Manitoba. 1886 

Dr. William Keener Sutherlin Mansfield, La. 1892 

Dr. R. M. SwEARiNGEN Austin, Tex. 1880 

E. F. SwiNNEY Kansas City, Mo. 1891 

Dr. Alexander N. Talley Columbia, S. C. 1890 

Dr. R. P. Talley Belton, Tex. 1880 

Dr. Fernando Tarraga, Juan Manuel 6 Mexico, Mex. 1892 

Albert B. Tavel, Esq Nashville, Tenn. 1879 

Dr. Knut Martin Olson Teigen, 341 9th Ave. S. . Fargo, N. Dak. 1891 

Dr. Carlos M. Tegeda, Puenta Jesus 9 Mexico, Mex. 1892 

Dr. A. P. Tenney, 540 Minnesota Ave Kansas City, Mo. 1891 

Dr. Juan Enriquez y Terrazas, 16 Ave. de la Independenda, 

Chihuahua, Mex. 1892 

Dr. Jose Terres, i* Relox I2i Mexico, Mex. 1892 

Dr. Alvin Thayer Erie, Pa. 1892 

Dr. Henry W. Thayer, 61 Center St Cony, Pa. 1892 

Dr. J. P. Thomas Pembroke City, Ky. 1889 

M. Louise Thomas, 680 Lexington Ave New York City. 1888 

Dr. Theodore G. Thobias New York City. 1888 

Dr. PiNCKNEY Thompson Henderson, Ky. 1879 

Dr. Sidney Thompson Kerrville, Tenn. 1887 

Dr. G. B. Thornton Memphis, Tenn. 1879 

Dr. A. D. R. Thrane Eau Claire, Wis. 1889 

J. L. Tobias Charleston, S. C. 1890 

Dr. Joseph H. Todd, 150 W. Tibert St Wooster, Ohio. 1892 

Dr. Joseph M. Toner Washington, D. C. 1872 

Dr. P. M. Toral Lagos, Jalisco, Mex. 1892 

Dr. Rafael Torreblanca Tenancingo, Mex. 1892 

Dr. iGNACio Torres Chihuahua, Mex. 1892 

Dr. Manuel Toussaint, Rinconada de San Diego 6 . . Mexico, Mex. 1892 

Dr. Manuel Tovar Morella, Michoacan, Mex. 1892 

Dr. Edwin C. Town, 309 N. 37th St Philadelphia, Pa. 1888 

Dr. Smith Townshend Washington, D. C. 1879 

Dr. Roger S. Tracy, 67 W. 37th St New York Qty. 1889 



REVISED LIST OF MEMBERS. 335 

Dr. Lorenzo Traver, 203 High St Providence, R. I. 1892 

Dr. iGNACio M. Trejo Mexico, Mex. 1892 

Dr. Jesus H. TreviIIo Monterey, Nuevo Leon, Mex. 1892 

Dr. R. J. Trippe, Loreman Building Chattanooga, Tenn. 1892 

Dr. Alcala L. Troconis Mexico, Mex. 1892 

Dr. Patricio Trueba Campeche, Campeche, Mex. 1892 

Dr. Thomas J. Turner, U. S. N Coldwater, Mich. 1877 

Dr. Thomas Jefferson Turpin Laredo, Tex. 1892 

Dr. Gerrard G. Tyrrell Sacramento, Cal. 1885 

Dr. Baltazar Uriarte Puebla, Puebla, Mex. 1892 

Dr. Alejando Uribe Mexico, Mex. 1892 

Dr. Fausto Uribe Giiadalajara, Jalisco, Mex. 1892 

Dr. Manuel Uribe Mexico, Mex. 1892 

Sr. Bernardo Urueta, 2* San Francisco 5 Mexico, Mex. 1892 

Dr. M. Fructuoso Valdez Saltillo Coahuila, Mex. 1892 

Dr. Jesus Valenzuela, Refugio 8 Mexico, Mex. 1892 

Dr. Joshua M. Van Cott, Jr., 188 Henry St. . . . Brooklyn, N. Y. 1889 

Dr. J. H. Van Deman Chattanooga, Tenn. 1873 

Dr. F. P. Vandenbergh Buflfalo, N. Y. 1888 

Dr. E. V. Van Norman San Diego, Cal. 1882 

Dr. Ely Van DE Warker Syracuse, N. Y. 1892 

Dr. Edurado Vargas Mexico, Mex. 1892 

Dr. B. A. Vaughan Columbus, Miss. 1882 

Dr. E. E. Vaughan Cambridge, Mass. 1887 

Dr. Victor C. Vaughan Ann Arbor, Mich. 1883 

Dr. Legorreta Octaviano Vazquez, i* Santo Domingo 8, Mexico, Mex. 1893 

Dr. S. Velazquez Atotonilco, Jalisco, Mex. 1892 

Prof. Frank Preston Venable Chapel Hill, N. C. 1890 

Dr. Antonio Verduzco Morelia, Michoacan, Mex. 1892 

Dr. F. Vergara Monterey, Nuevo Leon, Mex. 1892 

Dr. Joaquin Vertiz, Hospital Concepcion Beistigue . . Mexico, Mex. 1892 

Dr. Julio ViDEGARAY Morelia, Michoacan, Mex. 1892 

Dr. Erazo Leopoldo Vilchis Toluca, Mex. 1 892 

Dr. L. Villafuerto Mexico, Mex. 1892 

Dr. Jesus Villagran, Callejon, Santa Clara 7 .... Mexico, Mex. 1892 

Dr. Rafael Villamil Merida, Yucatan, Mex. 1892 

Dr. W. W. Vinnedge Lafayette, Ind. 1882 

Dr. Leopoldo ViRAMONTES Chilpancingo, Guerrero, Mex. 1891 

Dr. John H. Vivian Mineral Point, Wis. 1888 

Dr. Karl Von Ruck Asheville, N. C. 1890 

Dr. F. L. Von Suessmilch Delevan, Wis. 1889 

Dr. A. P. Waddell Union City, Tenn. 1861 

Dr. Spencer S. Wade Morgantown, W. Va. 1892 

Dr. Henry P. Walcott Cambridge, Mass. 1880 

Dr. Charles Finlay Waldron Oklahoma City, Oklahoma Territory. 1891 

Dr. Theron Augustus Wales Elmira, N. Y. 1892 

Dr. Jerome Walker, 8 Seventh Ave Brooklyn, N. Y. 1889 

Dr. T. P. C. Walker Dyersburg, Tenn. 1891 

Mr. Frank H. Wall, 25 W. S9th St New York City. 1892 

Dr. John P. Wall Tampa, Fla. 1875 



336 REVISED LIST OF MEMBERS. 

Dr. D. Wallace Terrell, Tex. 1889 

Dr. David L. Wallace Newark, N. J. 1885 

Shippen Wallace, Ph. D Burlington, N. J. 1885 

Dr. Ralph Walsh Washington, D. C. 1885 

Dr. James Samuel Ward Nashville, Tenn. 1892 

L. B. Ward, C. E Jersey City, N. J. 1885 

Dr. Horace Wardner La Porte, Ind. 1877 

Col. George E. Waring, C. E Newport, R. I. 1875 

Dr. R. P. Waring, ioio Grand Ave Kansas City, Mo. 1891 

Dr. L. D. Waterman Indianapolis, Ind. 1892 

Dr. Irving A. Watson Concord, N. H. 1881 

Dr. J. Madison Watson Elizabeth, N. J. 1882 

Dr. William S. Watson FishkiU-on-Hudson, N. Y. 1892 

Dr. Eugene Way Dennisville, N, J. 1892 

Dr. Joel Audubon Webb, 281 Manton Ave. . • Providence, R. I. 1892 

Albert L. Webster, C. E., 107 Drezel Building . . New York City. 1885 

Dr. Warren Webster, U. S. A Wells River, Vt. 1873 

Dr. Marshall J. Wellborn Atlanta, Ga. 1892 

Dr. Henry M. Wells, U. S. N Washington, D. C. 1889 

Dr. Joseph M. Wells Camden, N. J. 1887 

Dr. H. P. Wenzel Milwaukee, Wis. 1888 

Hon. James A. Weston Manchester, N. H. 1890 

Dr. William C. Wey Elmira, N. Y. 1892 

Alfred T. White, 40 Remsen St Brooklyn, N. Y. 1889 

Dr. Frank Sprague White Austin, Tex. 1892 

William A. White, 158 Columbia Heights .... Brooklyn, N. Y. 1888 

Dr. Albert W. Wilcox Laredo, Tex. 1892 

Dr. C. P. Wilkinson New Orleans, La. 1889 

Dr. Otho B. Will . Peoria, 111. 1892 

Dr. Jacob Lafayette Williams, i Mt. Vernon St. . Boston, Mass. 1892 

Dr. J. Louis Williamson Milwaukee, Wis. 1888 

Dr. H. L. Williford Memphis, Tenn. 1891 

Dr. G. H. Wilson, 50 Colony St Meriden, Conn. 1890 

Dr. Louis David Wilson, 80 1 2th St Wheeling, W. Va. 1892 

Dr. A. E. Winchell New Haven, Conn. 1886 

Dr. Uranus Owen Brackett Wingate, 204 Biddle St., Milwaukee, Wis. [890 

Dr. Simeon P. Wise Millersburg, Ohio. 1886 

Dr. G. F. Witter Grand Rapids, Mich. 1877 

Dr. Arthur S. Wolff Brownsville, Tex. 1892 

Mr. Alfred Vincent Wood, 115 Amherst St. . . . Brunswick, Ga. 1892 

Prof. Edward S. Wood Boston, Mass. 1876 

Deputy Surgeon Gen. A. A. Woodhull, U. S. A. . Hot Springs, Ark. 1874 

Dr. Philip B. Woodworth Lansing, Mich. 1892 

Dr. Thomas J. Woolf New Iberia, La. 1892 

Dr. Federico Guillermo Wooss .... Zacatecas, Zacatecas, Mex. 1892 

Dr. Olive E. Worcester Conant, Fla. 1892 

Dr. Nathaniel Eugene Wordin, 174 Fau^eld Ave. Bridgeport, Conn. 1890. 

William E. Worthen, C. E., 63 Bleeker St. . . . New York City. 1872 

Dr. Arthur L. Wright Carroll, Iowa. 1892 

Dr. A. R. Wright Buffalo, N. Y. i88i 



REVISED LIST OF MEMBERS. 337 

Dr. Franklin W. Wright New Haven, Conn. 1889 

Dr. John Wright Sardis, Miss. 1879 

Dr. James Henry Wroth Albuquerque, New Mexico. 1891 

Dr. Benjamin Franklin Wyman Aiken, S. C. 1890 

Dr. Walter Wyman, Super. Surgeon-General, U. S. 

M. H. S Washington, D. C. 1884 

Dr. W. M. Yandell El Paso, Tex. 1891 

Dr. Finis £ WING YoAKUNN Shreveport, La. 1892 

Dr. A. G. Young Augusta, Me. 1885 

Dr. Francis J. Young Bridgeport, Conn. 1887 

John Preston Young Memphis, Tenn. 1888 

Dr. Mariano Zuniga Mexico, Mex. 1892 

ASSOCIATE MEMBERS. 

Mr. Julius Brittlebach . Charleston, S. C. 1892 

Mr. J. Russell Burks, 358 Dearborn St Chicago, 111. 1892 

Sr. Jorge Carmona Mexico, Mex. 1892 

Mr. Frank J. DeMerritt, 3808 Ave. L Galveston, Tex. 1892 

Mr. John Philip Donworth Fort Payne, Ala. 1892 

Mr. C. H. Drayton, 25 East Battery St Charleston, S. C. 1892 

Mr. H. C. Edwards Dundee, 111. 1892 

Dr. John Emery Ennis, 489 Bowen Ave Chicago, 111. 1892 

Mr. A. A. Gallagher, 103 Read House .... Chattanooga, Tenn. 1892 

Mr. William Gravel, 788 Broadway New York City. 1890 

Mr. Will Gutman, 29 13th St Wheeling, W. Va. 1892 

Mr. Charles Albert Hill Flat Rock, N. C. 1892 

Mr. J. H. Hough, 227 No. High St Nashville, Tenn. 1892 

Mr. Thomas W. B. Hughes, 258 Broadway .... New York City. 1892 

Sr. Victor Josft M. Icaza Zoplelole (?), Mex. 1892 

Mr. F. G. Lasham, 15 Rutledge Ave Charleston, S. C. 1892 

Mr. Henry F. MacGregor, 2310 Fannin St. . . . Houston, Tex. 1892 

Mr. S. W. Manning, 332 Washington St Boston, Mass. 1892 

Mr. Charles Emery Miner, 105 No. Broadway . . St. Louis, Mo. 1892 

Mr. J. C. Moore Nashville, Tenn. 1892 

Mr. John Overton, Maxwell House Nashville, Tenn. 1892 

Mr. James M. Pace, Jr., 213 Main and Lanear Sts. . . Dallas, Tex. 1892 

Mr. Alexander L. Patrick Detroit, Mich. 1889 

Mr. Samuel A. Pointer Spring Hill, Tenn. 1892 

Mr. Arthur Frank Probasco, 218 High St. . . Chattanooga, Tenn. 1892 

Mr. Perley Putnam . , Laconia, N. H. 1892 

Mr. Frank Rees, 528 Richardson Block .... Chattanooga, Tenn. 1892 

Mr. S. W. Reynolds Boston, Mass. 1892 

Sr. Carlos Roumagnac, Sepilcros Santo Domingo 7 . . Mexico, Mex. 1892 

Mr. M. Shirk Tipton, Ind. 1892 

Dr. E. D. Smith Menasha, Wis. 1892 

Mr. Horace G. Thomas, 1707 Summer St Philadelphia, Pa. 1892 

Mr. William D. Thomas, 9 Lindsley Ave Nashville, Tenn. 1892 

Mr. E. T. TiFFT Springfield, Mass. 1892 

Mr. James C. Warner, 125 No. Spruce St Nashville, Tenn. 1892 

Mr. Joseph H. Warner Chattanooga, Tenn. 1892 



338 REVISED LIST OF MEMBERS. 

Mr. Leslie Warner, 13 Spruce St Nashville, Tenn. 1892 

Mr. Percy Warner, 127 No. Spruce St Nashville, Tenn. 1892 

Rev, Joseph Wild, D. D Toronto, Ont. i886 

Mrs. C. H. Wilson, 736 Flower St Los Angeles, Cal. 1892 

Mr. William Robert Wilson, 229 E. Terrace St. . Chattanooga, Tenn. 1892 

HONORARY MEMBERS. 

President Grover Cleveland New York City. 1885 

Dr. J. B. Russell, LL. D Glasgow, Scotland. 1886 

Mrs. Elizabeth Thompson New York City. 1887 

President Porfirio Diaz Mexico, Mez. 1892 

LIFE MEMBER. 

Henry Lomb Rochester, N. Y. 1884 



LIST OF MEMBERS ELECTED AT THE TWENTY-FIRST 

ANNUAL MEETING OF THE AMERICAN PUBLIC 

HEALTH ASSOCIATION, HELD AT CHICAGO, ILL., 
OCTOBER 9-14, 1893. 

Prof. J. George Adams, M. D., Prof. Pathology McGill Uni- 
versity Montreal, P. Q. 

Dr. Sabah H. Bbaytok Evanston, 111. 

Dr. Asa B. Bowebs Jackson, Iowa. 

Fbedebic Hathaway Bobbadaile, Chemist and Pharma- 
cist 41 Michigan Aye., Detroit, Mich. 

Dr. Chas. Caldwell, Registrar of Vital Statistics, 8287 Ind. Ave., Chicago, 111. 

Dr. Ja3(es Campbell, President Hartford Board of Health . Hartford, Conn. 

Lanodon T. Chbistian, Chairman Com. on Health, City 

Council 1215 £. Broad St., Richmond, Ya. 

Fbaitk B. Clabk, Merchant .... 888 Wabash Ave., Chicago, 111. 

Miss Emma O. Coitbo, Director Dept. Domestic Science, Pratt 

Institute Brooklyn, N. Y. 

Dr. A. W. Cbow, City Physician and Sanitary Superintendent 

1880 Grand Aye., Kansas City, Mo. 

Dr. Chablbs Gilman Citbbieb .... 75 West 56th St., New York. 

Dr. John Habyby Davisson, Member California State Board 

of Health 1442 Pleasant Ave., Los Angeles, Cal. 

Fbank L. Falbs, C. E., Asst Engineer Experiment Station, 

Massachusetts State Board of Health, (Care Essex Co.) Lawrence, Mass. 

Dr. Gboboe S. Fosteb Putney, Yt. 

Geobge W. Fulleb, Bacteriologist in charge Lawrence Exper- 
iment Station, Mass. State Board of Health, Experiment 
Station Lawrence, Mass. 

Dr. E. Gabbott 751 Washington Boulevard, Chicago, 111. 

Dr. J. M. Hall Chicago, HI. 

Col. Bebnabd J. D. IBWIN, M. D., U. S. A., Care War Dept., Washington, D. C. 

Dr. Jestts JiMEinsz, Physician and Surgeon, Calle de Palacio, 

2di Guadalajara, Mex. 

Dr. S. J. Jones Chicago, 111. 

Dr. Job:n T. Kennedy, Physician and Surgeon, 107 East 20th St, New York. 

Dr. R. D. Kahle, Member State Board of Health .... Lima, O. 

Dr. Albebt Leffinowell, Physician and Surgeon . . . Summit, N. J. 

Dr. JuLLA Ross Low 

Thos. H. McEJCNziE, C. E., Member State Board of Health, Southington, Conn. 

Dr. WiLLLAM T. Mahon Chamois, Mo. 

Dr. C. H. Mabquabdt, Physician and Surgeon, Member State 

Board of Health, La Crosse, Wis. 

Dr. W. Q. Mabsh, Surgeon Mexican Northern R. R., 

Sierra Mojada, Coskhuila, Mex. 

HowABD MuBPHY, Civil and Sanitary Engineer, Member State 

Board of Health 826 Walnut St, Philadelphia, Pa. 

Dr. WoLFBED Nelson Astor House, New York City. 

Dr. Chablbs Wilbbb Ntjttino, Member State Board of Health, Etna, Cal. 



340 LIST OF MEMBERS ELECTED. 

Dr. J. H. O'DoNNELL, Chainnan Provincial Board of Health, 

Winnipeg, Manitoba. 
Dr. William T. Oppbnheimxb, Health Officer .... Richmond, Ya. 
Mrs. Habbiette M. PmmETT, President House of Mercy 

Hospital 156 East St, Pittsfield, Mass. 

Dr. Maurice Pbttchabd, Health Officer, President Board of 

Health Sierra Valley, Cal. 

Dr. Edwabd O. Reii.lt, Member State Board of Health . . Elizabeth, K. J. 
Dr. Eliza H. Root, Prof. Hygiene and Medical Jurisprudence, 

Woman's Medical School, Northwestern University . . Chicago, 111. 

Dr. A. R. Retnolds, Commissioner of Health Chicago, HL 

Dr. R. F. RuTTAN, Lecturer on Hygiene, McGill University . Montreal, P. Q. 

J. Rump, C. E Copenhagen, Denmark. 

Chables R. Sakoeb, Prof, of Chemistry, Washing^n University, St Louis, Mo. 

Dr. Sabah Hackett Stevenson Chicago, HI. 

Miss Ada Sweet, Vice-President Municipal Order League, 

175 Dearborn St, Chicago, HI. 
Miss Mabion Talbot, Asst Prof. Sanitary Science, University 

of Chicago University of Chicago, Chicago, HI. 

Mr. Fbank Wells, President State Board of Health . . Luising, Mich. 
Dr. Chableb P. Wbbtenbaksb, P. A. Surgeon, U. S. M. H. S., Chicago, HL 

Dr. William LeRoy Wilcox Irving Park, Chicago, HI. 

Chableb M. Wilkbb, Civil Engineer, Asst Engineer Water 

Supply, World's Exposition 
Dr. Fbakk W. Weight, Health Officer . . 48 Pearl St, New Haven, Conn. 



SANITARY AUTHORITIES AND ASSOCIATIONS 

OF THB 

UNITED STATES OF AMERICA, CANADA, AND MEXICO. 

1894. 



REVISED EDITION. 



AMERICAN PUBLIC HEALTH ASSOCIATION. 

President, Dr. E. P. Lachapelle, Montreal, P. Q. 

First Vice-President, Dr. M. Garmona y Valle, Mexico, Mex. 

Second Vice-President, Dr. J. N. McCormack, Bowling Green, Ky, 

Secretary, Dr. Irving A. Watson, Concord, N. H. 

Treasurer, Dr. Henry D. Holton, Brattleboro, Vt. 

NATIONAL CONFERENCE OF STATE BOARDS OF HEALTH. 

President, Dr. C. A. Lindsley, New Haven, Conn. 
Vice-President, Dr. Irving A. Watson, Concord, N. H. 
Secretary, Dr. C. O. Probst, Columbus, Ohio. 
Treasurer, Dr. Henry B. Ba^er, Lansing, Mich. 

UNITED STATES MARINE HOSPITAL SERVICE. . 
Supervising Surgeon-Gtoneral, Dr. Walter Wyman, Washington, D. C. 

PROVINCIAL BOARD OF HEALTH OF NOVA SCOTIA. 

Hon. W. S. Fielding, Premier and Provincial Secretary^ Chairman; A. P. Reid, 
Esq., M. D., Medical Superintendent Victoria General HoepUal^ Halifax, Sec- 
retary; Hon. J. W. Longley, Attorney General; Hon. C. £. Church, Commis-' 
eioner qf Public Works and Mines; Wm. H. MacDonald, Esq., M. D., Anti- 
gonisb; Edward Farrell, Esq., M. D., Halifax, F. W. Borden, Esq., M. D., 
Canning; A. S. Kendall, Esq., M. D., Sydney; Qeo. L. Sinclair, Esq., M. D., 
Superintendent Nova Scotia Hospital for Insane^ Halifax. 

THE PROVINCIAL BOARD OF HEALTH OF ONTARIO. 

Dr. John Duff Macdonald, Hamilton, Chairman; Dr. Peter H. Bryce, Toronto, 
Secretary; Dr. Charles W. Covernton, Toronto; Dr. J. J. Cassidy, Toronto; 
Dr. Fancis Rae, Oshawa; Dr. H. E. Vaux, Brockville; Dr. E. E. Kitchen, St 
(George. 



342 SANITARY AUTHORITIES AND ASSOCIATIONS. 

BOARD OF HEALTH OF THE PROVINCE OF QUEBEC. 

Dr. £. P. Laohapelle, Montreal, President; Dr. Elz^ar Pelletier, Montreal, Secre- 
tary; Dr. J. A. Beaudry, Montreal, Inspector qf Health; Dr. Wyatt Johnston, 
Montreal, Bacteriologist; Dr. R. F. Buttaw, Montreal, Chemist; Dr. L. J. H. 
Roy, Montreal, Becorder of Statistics; H. R. Gray, Montreal; Dr. Robert 
Craik, Montreal; Dr. Alphonse M^thot, Trois Rivieres; Dr. J. I. DesRoches, 
Montreal; Dr. Laurent Gatellier, Quebec. 

PROVINCIAL BOARD OF HEALTH OF NEW BRUNSWICK. 

Dr. William Bayard, St John, Chairman; Dr. George E. Coulthard, B. A., Fred* 
ericton. Secretary; Hon. Judge Steadman, Fredericton; Hon. Jamea Holly, 
St. John; Dr. Qeorge H. Cobum, Frederickton; John McMillan, Esq., St. 
John. 

MANITOBA. 

Dr. John H. O'Donnell, Winnipeg, Chairman; Dr. C. J. Jamison, Winnipeg, Sec- 
retary; Dr. A. H. Ferguson, Winnipeg; Dr. J. H. Brook, Winnipeg; Dr. C. 
C. Aubrey Hushend, Moosomin post-office, Manitoba; Dr. Chown, Winnipeg, 
Moosomin post-office, Manitoba; Dr. Torrence, Y. S., Brandon post-office, 
Manitoba. 

THE SUPERIOR BOARD OF HEALTH OF MEXICO. 

COITBEJO. 

Presidente, Dr. Eduardo Lic^aga, San Andres ndm. 4. 

Yocal, Dr. Agustln Reyes, Bajos de San Agustin 7. 

Yocal, Dr. Domingo Orvafianos, Chavarria ntim. 25. 

Yocal, Dr. Nicole R. de Arellano, Medinas num. 11. 

Yocal, Dr. Juibi J. R. de Arellano, la. de Soto ndm. 8. 

Yocal Medico Militar, Dr. Alberto Escobar, 11a. Callej6n de la Yioleta 4. 

Yocal Medico Militar, Dr. Fernando L6pez, Espieritu Santo 5. 

Yocal Medico Yeterinario, Professor Jos^ L. G6mez, Cocheras nlim. 12. 

Yocal Farmac^utico, Professor Jos^ D. Morales, Hospicio, San Kichol^ 18. 

Yocal Licendiado, Sr. Jos^ M. Gamboa, Donceles ntim. 4. 

Yocal Ingeniero, Sr. Roberto Gayol, Cerrada de Santa Teresa 4. 

SBCBETABIA. 

Secretario General, Dr. Jos^ Ramirez, Buenavista ntim. 1626. 
Oficial lifayor, Sr. Andr^ Alva, Tacubaya, la. de la Palma 8. 
Jefe de la Secci6n la., Sr. Pedro Mayoli, Tarasquillo nlim. 7. 
Jef e de la Secci6n 2a., Sr. Enrique Rangel, San Felipe de Jestis 9. 
Jefe de la Secci6n, 8a., Dr. Jos^ Alfaro, la. de la Colonia 6. 

Oficial archivero y de partes, Sr. Ju^ M. , del Hotel Central 68. 

Escribiente, Sr. Manuel Flores Heras, Plazuela Tlaxcaltongo 28. 
Sscribiente, Sr. Carlos A. Morales, Arsinas 12. 
Escribiente, Sr. Daniel Argudin, 8a., de San Juan 4. 
Escribiente, Sr. Francisco Lopez, Callej6n de Betlemitas 2. 
Escribiente, Sr. Adrian Guichenn^, Puente de los Gallos 8. 
Escribiente, Sr. Diego Rivera, Cerrada de la Misericordia 8. 

TK80RBBIA. 

Tesorero, Sr. Jacinto Manterola. Tacubaya, f te. la Condesa. 

SANITARY COUNCIL OF THE MISSISSIPPI VALLEY. 
President, Dr. J. D. Plunket, Nashville, Tenn. 



SANITARY AUTHORITIES AND ASSOCIATIONS, 343 

STATE BOARDS OF HEALTH. 

AT.A-RAMA . 

Dr. Jerome Cochran, Montgomery, State Health Officer, (The Alabama State 
Medical Association constitutes the State Board of Health.) 

ABKANSA8. 

Dr. John I. Hancock, Argenta, President; Dr. R. G. Jennings, Little Rock, Seo- 
retary; Dr. G. W. Hudspeth, Hazen; Dr. W. A. Cantrell, Little Rook; Dr. 
R. N. Ross, Lonoke; Dr. J. M. Park. 

CALXFOKEOA. 

Dr. C. W. Nutting, Etna Mills, President; Dr. Winslow Anderson, San Francisco, 
Vice-President; Dr. J. R. Laine, Sacramento, Secretary; Dr. C. A. Ruggles, 
Stockton; Dr. W. F. Wiard, Sacramento; Dr. P. C. Remondino, San Diego; 
Dr. J. H. Davisson, Los Angeles. 

COLORADO. 

Dr. A. Stedman, Denver, President; Dr. Henry Sewall, Denver, Secretary; Dr. 
W. P. Munn, Denver, Treasurer; Dr. Edmund J. A. Rogers, Denver; Dr. R. W. 
Corwin, Pueblo; Dr. B. F. Wooding, Trinidad; Dr. H. R. Bull, Grand Junc- 
tion; Dr. S. P. Green, Aspen; Dr. H. C. Crouch, Colorado Springs. 

CONNECTICUT. 

Prof. Wm. H. Brewer, Ph. D., New Haven, President; Prof. C. A. Lindsley, 
M. D., New Haven, Secretary; Dr. G. H. Wilson, Meriden; Dr. R. S. Gk>odwin, 
Thomaston; Dr. N. E. Wordin, Bridgeport; T. H. McKenzie, C. E. Southing- 
ton; Geo. P. IngersoU, Esq., New Haven. 

DELAWARE. 

Dr. E. W. Cooper, Camden, President; Dr. E. B. Frazer, Wilmington, Secretary; 
Dr. B. L. Lewis, Harrington; Dr. David L. Mustard, Lewes; Dr. Wm T. 
Skinner, Glasgow; Dr. Lrving S. Yallandigham, Middletown; Dr. R. G. EUe- 
good, Concord; Dr. Alex Lowber, Wilmington. 

FLORIDA. 

Hon. W. B. Henderson, Tampa, President; Dr. Joseph Y. Porter, Jacksonville 
and Key West, State Health Offlcer and Secretary; Hon, J. P. Talliaferro, 
Jacksonville; Dr. W. E. Anderson, Pensacola. 

GEORGIA. 

(This state formerly had a state board of health, but has allowed it to become 
extinct, from lack of appropriations.) 

ILLINOIS. 

Dr. William E. Quine, Columbus Memorial Building, Chicago, President; Dr. B. 
M. Griffith, Springfield, Treasurer; Dr. John A. Vincent, Springfield; Dr. 
George Thilo, 465 Milwaukee Ave., Chicago; Dr. Sarah Hackett Stevenson, 
Yenetine Building, Chicago; Dr. James B. McFatrich, Masonic Temple, 
Chicago; Dr. Julius Kohl, Belleville; Dr. J. W. Scott, Springfield, Secre- 
tary, 



344 SANITARY AUTHORITIES AND ASSOCIATIONS. 



IDAHO. 



(Has no state board of health* Proyision is made for the appointment of health 
officers by the various boards of county commissioners; but they are answer- 
able to the local authorities only.) 



nn)iAHA« 

Dr. S. S. Boots, Greenfield, President; Dr. L. L. Whitesides, Franklin, Vice- 
President; Dr. C. N. Metcalf, Indianapolis, Secretary; Dr. John N. Taylor, 
Crawfordsville; Dr. D. C. Ramsey, Mt. Yemon* 

IOWA. 

Dr. Frederick Becker, Claremont, President; Dr. J. F. Kennedy, Des Moines, 
Secretary; Dr. J. A. Scroggs, Keokuk: Dr. John C. Shrader, Iowa City; Dr. 
E. H. Carter, Des Moines; Dr. E. A. Guilbert, Dubuque: Dr. J. M. Emmert, 
Atlantic; Dr. R. E. ConnifF, Sioux City; James L. Loring, C. E., Dallas Cen- 
tre; John Y. Stone, attorney-general, ez officio; M. Stalker, Ames, state vet- 
erinary surgeon, ex officio, 

KANSAS. 

Dr. J. P. Stewart, Clay Centre, President; Dr. H. A. Dykes, Topeka, Secretary; Dr. 
B. E. Jones, Buffalo; Dr. P. Daugherty, Junction City; Dr. A. J. Anderson, 
Lawrence; Dr. Thos. Kirk, Jr., Burr Oak; Dr. E. Swarts, Kansas Cily, Kan.; 
Dr. J. W. Jenney, Salina; Dr. E. M. Hoover, Halstead; Dr. H. W. Roby, 
Topeka; L. M. Powell, Chemist and Microscopist^ Topeka. 

KSNTUOKY. 

Dr. Joseph M. Matthews, Louisville, President; Dr. J. K. McCormack, Bowling 
Green, Secretary; Dr. William Baily, Louisville; Dr. J. A. Lucy, Frankfort; 
Dr. George Beeler, Clinton; Dr. J. O. McReynolds, Elkton; Dr. Arch Dixon, 
Henderson. 

LOUISIANA. 

Dr. S. R. OUiphant, 111 Prytania St., New Orleans, President; Dr. Will. R. Har- 
nan, 68 Carondelet St., Kew Orleans, Secretary; Dr. F. Fermento, 81 Es- 
planade St., New Orleans; Dr. George K. Pratt, 152 Prytania St, New Or- 
leans; Dr. 0. E. Kells, 12 Dauphine St, New Orleans; Mr. Wm. B. Hay- 
ward, 161 Robin St, New Orleans; Dr. C. J. Biokham 220 Jackson Ave., New 
Orleans; Dr. G. Farrar Patton, cor. Camp and Gainnic St, New Orleans; 
Mr. S. Odenheimer, 460 Camp A., New Orleans. 

MAINE. 

Dr. C. D. Smith, Portland, President; Dr. A. G. Young, Augusta, Secretary; 
E. C. Jordan, C. E., Portland; Prof. F. C. Robinson, Brunswick; Dr. A. R. 
G. Smith, North Whitefield; Dr. G. M. Woodcock, Bangor; Dr. M. C. Wedge- 
wood, Lewiston. 

MABYLAND. 

Dr. John Morris, Baltimore, President; Dr. James A. Stewart, Baltimore, Secre- 
tary and Executive Officer; I. Crawford Neilson, C. E., Baltimore; Dr. I. M. H. 
Bateman, Eaton; Dr. John N. lamar, Elkton; Dr. James F. McShane, Health 
Commissioner of Baltimore City, ex officio; Hon. John P. Poe, attorney- 
general, Baltimore, ex officio. 



SANITARY AUTHORITIES AND ASSOCIATIONS. 345 



MA88A0HUSETT8. 

Dr. Henry P. Walcott, Cambridge, Chairman; Dr. Samael W. Abbott, Boston, 
Secretary: Dr. Frank W. Draper, Boston; Hiram F. Mills, C. E,, Lawrence; 
Dr. Joseph W. Hastings, Warren; G. C. Tobey, Esq., Wareham; J. W. Hull, 
Pittsfield; Charles H. Porter, Quincy; F. P. Steams, C. E., Engineer. 

MICHIGAlf. 

Hon. Frank Wells, Lansing, President; Dr. Henry B. Baker, Lansing, Secretary; 
Dr. Victor C. Vaughan, Ann Arbor; Prof. Delos Fall, Albion; Dr. Mason W. 
Gray, Pontiac; Dr. Geo. H. Granger, Bay City; Dr. Samuel G. Milner, Grand 
Bapids. 

MUnrESOTA. 

Dr. Franklin Staples, Winona, President; Dr. Charles N. Hewitt, St. Paul, 
Secretary; Dr. Perry H. Millard, St Paul; Dr. Wm. J. Mayo, Rochester; Dr. 
Kneut Hoegh, Minneapolis; Dr. C. F. McComb, Duluth; Dr. W. H.Leonard, 
Minneapolis; Dr. Edward Boeckman, St. Paul; Dr. W. L. Beebee, St Cloud. 

MISSISSIPPI. 

Dr. W. F. Hyer, Meriden, President; Dr. Wirt Johnson, Jackson, Secretary; Dr. 
W. B. Sanford, Corinth, Dr. J. F. Hunter, Jackson, Dr. H. H. Haralson, 
Forest, Dr. S. R. Dunn, Greenville, Dr. H. A. Gant, Water Valley, from the 
state at large; Dr. J. M. Greene, Aberdeen, First District; Dr. John Wright, 
Sardis, Second District; Dr. R. S. Toombs, Greenville, Third District; Dr. B. 
F. Kittrell, Black Hawk, Fourth District; Dr. W. F. Hyer, Meriden, Fifth 
District; Dr. E. F. Griffin, Moss Point, Sixth District; Dr. Wirt Johnston, 
Jackson, Seventh District. 

MISSOURI. 

Dr. F. J. Lutz, St Louis, President; Dr. A. W. McAlister, Columbia, Vice-Presi- 
dent; Dr. Willis P. King, Kansas City, Secretary; Dr. J. D. Griffith, Kansas 
City; Dr. T. H. Hudson, Kansas City; Dr. Albert Merrill, St Louis; Dr. 
Paul Paquin, Lebanon. 

NEBBASKA. 

Dr. J. V. Beghtol, Friend, President; Dr. C. F. Stewart, Auburn, Vice-President; 
Dr. F. D. Haldeman, Ord, Secretary; Dr. E. T. Allen, Omaha, Treasurer; 
L. Crounse, Lincoln, Oovemor; George H. Hastings, Lincoln, Attomey-Oen- 
eral; A. K. Goudy, Supt. Public InstructiOTi, 

NEVADA. 

Dr. S. L. Lee, Carson City, President; Dr. J. A. Lewis, Reno, Secretary; Dr. J. J. 
Henderson, Elko. 

NEW HAMPSHIBE. 

Dr. G. P. Conn, Concord, President; Dr. Lrving A. Watson, Concord, Secretary; 
Gk)v. John B. Smith, Hillsborough, ex offlcio; Attorney-General E. G. East- 
man, Exeter, ex officio; Hon. James A. Weston, Manchester; Dr. John J. 
Beny, Portsmouth. 

NEW JEBSEY. 

Dr. C. F. Brackett, LL. D., Princeton, President; Dr. Henry Mitchell, Asbury 
Park, Secretary; Dr. E. B. O'Reilly, Elizabeth; Hon. Henry C. Kelsey, sec- 



346 SANITARY AUTHORITIES AND ASSOCIATIONS. 

retary of state, esc oSicio; Hon. John P. Stockton, LL. D., attorney-general, 
esB officio; John Smock, Ph. D., state geologist, ex officio; Dr. Laban Dennis, 
Newark; Dr. Franklin Gkiontt, Burlington; Prof. A. R. Leeds, Ph.D., 
Hoboken; Dr. Cornelius Sheppard, Trenton. 

NEW YOBK. 

Dr. Florence O. Donohue, Syracuse, President ; Dr. William E. Millbank, Albany; 
Mr. Henry G. Wolcott, Fishkill-on-Hudson; Dr. John Edwards, Gloversville; 
Dr. Cyrus Edson, New York City; Dr. Murray M. Adams, Watertown; Hon. 
T. E. Hancock, attorney-general, Albany, ex officio; Hon. Campbell W. Adams, 
state engineer, Albany, ex officio ; Dr. Wm. T. Jenkins, Health Officer, port 
of New York, Stapleton, ex officio ; Dr. J. F. Barnes, Watkins, Secretary. 

KOBTH CABOLIKA. 

Dr. H. T. Bahnson, Salem, President; Dr. S. Westray Battle, Asheville; Dr. 
W. H. Harrell, Williamston; Dr. Geo. Gillett Thomas, Wilmington; Dr. 
W. H. G. Lucas, White Hall; Dr. John Whitehead, Salisbury; Prof. F. P. 
Yenable, Chapel Hill; J. C. Chase, civil engineer, Wilmington; Dr. Richard 
H. Lewis, Raleigh, Secretary and Treasurer, 

NORTH DAKOTA. 

Hon. W. H. Standish, attorney-general, Bismarck, President ; Dr. J. Q. Quick, 
Wahpeton, Vice-President ; Dr. F. H. De Vaux, Valley City, Si^erintendent 
and Executive Offlcer, 

OHIO. 

Dr. B. Stanton, Cincinnati, President ; Dr. Thomas C. Hoover, Columbus, Vice- 
President ; Dr. E. T. Nelson, Delaware; Dr. Wm. T. Miller, Cleveland; Josiah 
Hartzell, Canton; Dr. S. P. Wise, Millersburg; Dr. R. D. Kahle, Lima; John 
K. Richards, attorney-general, ex officio; Dr. C. O. Probst, Columbus, 
Secretary. 

OKLAHOMA TEBBITOBT. 

L. L. Parker, Kingfisher, President; Dr. C. F. Waldron, Oklahoma City, Vice- 
President ; Dr. C. D. Arnold, El Reno, Secretary. 

OREGON. 

(Has no state board of health, or state sanitary association.) 

PENNSYLVANIA. 

Hon. Samuel T. Davis, M. D., Lancaster, President; Dr. Benj. Lee, Phila- 
delphia, Secretary ; Dr. Pemberton Dudley, Philadelphia; Dr. J. H. McClel- 
land, Pittsburgh; Howard Murphy, C. E., Philadelphia; Dr. George G. 
Groff, Lewisburg; Richard Y. Cook, Philadelphia. 

RHODE ISLAND. 

Dr. A. G. Sprague, River Point, President ; Dr. Gardner T. Swarts, Providence 
Secretary; Dr. P. S. Redfield, Providence; Rev. Geo. L. Locke, Bristol; 
S. M. Gray, C. E., Providence; Dr. A. B. Briggs, Hopkinton; Dr. Peter F. 
Curley, Newport. 



SANITARY AUTHORITIES AND ASSOCIATIONS, 347 



SOUTH CABOLINA. 



Dr. J. R. Bratton, Yorkville, Chairman; Dr. T. Grange Simons, Charleston, 
Vice-Chairman ; Dr. H. D. Fraser, Charleston, Secretary ; Dr. W. H. Nardin, 
Anderson; Dr. C. R. Taber, Fort Motte; Hon. D. A. Townsend, attorney- 
general, ex officio ; Hon. W. H. Ellerbe, comptroller-general, ex officio ; Dr. 
A. A. Moore, Camden; Dr. James Evans, Florence. 

TENNB88BB. 

Dr. J. D. Plunket, Nashville, President; Dr. James M. Safford, Nashville, Vice- 
President; Hon. E. W. Cole, Nashville; Dr. F. L. Sim, Memphis; Dr. P. D. 
Sims, Chattanooga; Dr. Daniel F. Wright, Clarksville; Dr. J. Berrien Linds- 
ley. Secretary. The secretary is not a member of the board. 

TEXAS. 

Dr. R. M. Swearingen, Austin, State Health Officer. 

VEBHONT. 

Dr. C. S. Caverly, Rutland, President ; Dr. J. H. Hamilton, Richf ord, Secretary ; 
Dr. O. W. Sherwin, Woodstock. 

wASHnroTON. 

Dr. J. R. Hathaway, Everett, President ; Dr. G. S. Armstrong, Olympia, Secre- 
tary; Dr. N. Fred Essig, Spokane; Dr. J. B. Eagleson, Seattle; Dr. John T. 
Lee, D. V. S., Tacoma. 

WEST VIBGINIA. 

Dr. W. P. Ewing, Charleston, President ; Dr. N. D. Baker, Martinsburg, Secre- 
tary; Dr. W. M. Late, Bridgeport; Dr. L. D. Wilson, Wheeling; Dr. B. H, 
Hoyt, Spencer; Dr. G. T. Dailey, Ronmey; Dr. W. C. Beard, Alderson, 
There are two vacancies at present. 

wiscoNBnr. 

Dr. Solon Marks, Milwaukee, President; Dr. U. O. B. Wingate, Milwaukee, 
Secretary ; Dr. J. T. Reeve, Appleton; Dr. F. H. Bodenius, Madison; Dr. C. 
H. Marquardt, La Crosse; Dr. Henry Day, Eau Claire; Dr. J. W. Hancock, 
Ellsworth. 

WYOMING. 

(Has no state board of health, or state sanitary organization.) 



SANITARY ASSOCIATIONS. 

CALIFOBIHA. 

State Sanitary Convention is held under the auspices of the State Board of 
Health. 

Dr. H. D. Orme, Los Angeles, President; Dr. Wm. H. Mays, Stockton, First Vice- 
President; Dr. M. Regensberger, San Francisco, Second Vice-President; 
Dr. Winslow Anderson, San Francisco, Secretary. 



348 SANITARY AUTHORITIES AND ASSOCIATIONS. 

IOWA PT7BLIC HSALTH ASSOCIATION. 

Dr. J. F. Kennedy, Des Moines, Pretldent ; J. P. Donahue, Davenport, First Vice- 
President; Dr. F. W. Wieland, Dubuque, Second Vice-PreMent ; Dr. P. J 
Fullerton, Haymond, Secretary and Treasurer. 

MASSACHUSBTTS AS80CIATI0K OF BOABDS OF HEALTH. 

Dr. H. p. Walcott, Cambridge, President; Dr. S. H. Durgin, Boston, First Vice- 
President; Dr. S. W. Abbott, Wakefield, Second Vice-President; Dr. L. F. 
Woodward, Worcester, Secretary ; Dr. James B. Field, Lowell, Treasurer. 

irOBTH OABOUNA BAHITABT ABSOCIATIOIT. 

Hon. A. A. Thompson, Raleigh, President; Hon. J. J. Fowler, Wilmington, 
W. E. Fountain, Esq., Tarboro*, and £. B. Neave, Esq., Salisbury, Vice- 
Presidents ; Dr. Julian M. Baker, Tarboro', and J. C. Chase, Esq., Wilmington, 
Secretaries^ 

THE STATE ASSOCIATED HEALTH AUTHOBITIBS OF PEmfSYLVAlTIA. 

His Excellency, Robert E. Pafctison, governor of Pennsylvania, ex officio^ President ; 
Moses Yeale, Esq., Philadelphia, First Vice-President ; Hon. Thomas Merritt, 
Reading, Second Vice-Preeident; Dr. J. H. McClelland, Pittsburgh, Third Vice- 
President; Dr. W. B. Atkinson, Philadelphia, 1400 Pine street, Secretary; 
Jesse C. Green, D. D. S., West Chester, Treasurer. 

BXE0I7TIVE HEALTH OFFICEBS' ASSOOIATIOIT OF OKTABIO. 

Willis Chipman, C. E., Toronto; Dr. J. J. Cassidy, Toronto; Dr. J. D. Macdon- 
ald, Hamilton; Dr. E. E. Kitchen, St George; Dr. J. W. Coventry, Windsor; 
Dr. E. Griffin, Brantford; Dr. C. Sheard, Toronto; Dr. N. Walker, Toronto; 
Dr. C. A. Hodgetts, Toronto; Dr. P. H. Bryce, Toronto; Dr. H. Howitt, 
Guelph; Dr. A. McKinnon, Guelph; F. T. Shutt, Ottawa; D. McCrae, 
Guelph; Dr. W. H. Lowry, Guelph: Dr. H. S. Martin, Erin; Robert Barber, 
Toronto; A. Macdougall, C. E., Toronto; J. J. Mackenzie, Toronto; Dr. H. E. 
Vaux, Brockville; Dr. D. P. Bogart, Wfiitby; Dr. A. Cameron, Owen 
Sound; Dr. W. R. Hall, Chatham; WiUiam Elliot, Seaforth; Dr. S. Lett, 
Guelph: Dr. M. McCrimmon, Palermo; Dr. J. Algie, Alton; Samuel Ryding, 
Toronto Junction; Dr. W. O. Robinson, St Jacobs; Dr. S. Snyder, Elmira; 
Dr. J. A. Robertson, Stratford; H. J. Bowman, C. E., Berlin; Dr. A. Stewart, 
Pahnerston; Dr. C. Macdonald, Tilsonburg; Dr. J. Wallace, Alma; Dr. J. H. 
Kennedy, Guelph; Dr. W. O. Stewart, Guelph; Dr. J. M. Cameron, Arthur; 
Dr. R. Carney, Windsor: Dr. S. Stewart, Thamesville: Dr. Francis Rae, 
Oshawa: E. Jackson, Tilsonburg; Dr. F. H. Mitchell, Delaware; T. L. 
McRitchie, Harwich; Dr. Robert Paul, Delaware; Dr. James H. Duncan, 
Chatham; A. H. White, Chatham; Dr. W. R. Nichols, Baden; Dr. David J. 
Minchin, Berlin; Dr. T. Y. Hutchinson, Toronto; Dr. J. B. Lundy, Preston; 
Dr. William W. Hay, Wallaceburg; Dr. George T. McKeough, Chatham; Dr. 
J. A. McLeay, Watford; Dr. Charles Chamberlain, Leamington; Dr. C. B. 
Langford, Blenheim. 



INDEX. 



The names of persons found in this volume, whether given as author, quoted, or 
referred to, with a few exceptions, appear in the index. The large-faced type indicates 
the subject of papers. 



Page. 

Abbott, Dr. S. W., on national registration a necessity . .... 63 

remarks by 2S4, 285 

Address, President's, Dr. Samuel H. Durgin 1 

Vice-President's, Dr. Eduardo Lic^aga 13 

of Welcome, by Charles C. Bonney, Esq 15 

Advisory Council, report of members of 291 

Alfi^u^as refleziones aoerca de la inf eooion y el oontagio del tif o 

ezantematiOO, by Dr. Ram6n Icaza 268 

Allen, Dr. Charles W., concerning leprosy 250 

An experiment in disinfection: how an epidemic of pneumonia 

was checked, by Jerome Cochran, M. D 21 

Animal vaccine— why it should be preferred to human vaccine, 

by Miguel Marquez, M. D 84 

Apuntes sobre la escarlatina en la oiudad de Puebla, Mexico, 

by Dr. Francisco Marin 216 

Atkinson, Dr. V. T., obituary 299 



Bacteria, pathogenic, removal of, from drinking water by sand filtration 152 

Bacteriology of tropical diarrhoea 36 

Bailey, Dr. William 283 

on typhoid fever 264 

Baker, Dr. Henry B., 281, 282, 283 

on quarantine 278 

Barbers' shops, hygiene of 81 

Bichloride of mercury as a disinfectant 280 

Billings, Dr. J. S., on the census statistics of leprosy 247 

Bonney, Mr. Charles C, address of welcome 15 

remarks by 261 

Bowen, Dr. John T., concerning leprosy 251 

Brandao, Dr. Julio, on a brief notice of the climate and diseases of Brazil, espe- 
cially of the city of Rio de Janeiro 182 

Brayton, Dr. Sarah H., on how can women best promote public sanitation ? . . 178 

remarks by 268 

Brazil, brief notice of the climate and diseases of ...*.. . 182 

Brewer, remarks by 294 

Brief notice of the climate and diseases of Brasil, especially of 

the city of Bio de Janeiro, by Dr. Julio Brandao . • . . 182 



350 INDEX, 

British Columbia quarantine station 96 

By-Laws of executive committee 305 

C 

Cameron, Sir Charles A., on the importance of civil public hygiene to the state . 186 

Canada, quarantine system of 92 

Can syphilitic contagion form the vehicle for the transmission 

of tuberculosis as well? Dr. Manuel Carmona y Valle . 204 
Carmona y Valle, inoculation to secure immunity from yellow-fever . . .130 

remarks by * . . 269^ 286 

on can syphilitic contagion form the vehicle for the transmis- 
sion of tuberculosis as well ? 204 

on yellow coloration of persons attacked by *' vomito prieto " . 89 

Charlottetown, P. £. I., quarantine station 95 

Chatham, Miramichi, N. B., quarantine station 96 

Chicago, deaths from all causes, 1892, 1893 149 

Municipal Order League and its work 177 

water-supply of : its source and sanitary aspect 146 

Cholera, deaths from, in Hull, £ng 31 

notes on its management in Hull, Eng 25 

Cholera Infantum : its treatment, by Manuel Septi^n .... 88 

Climate of Brazil, brief notice of 182 

Cochran, Dr. Jerome 21, 285, 289, 290, 293 

on an experiment in disinfection : how an epidemic of pneu- 
monia was checked 21 

Coleman-Stuckert cooperative family homes 116 

Committee on " Nomenclature of Diseases and Forms of Statistics," resolution 

creating 290 

Committees, reports of, on restriction and prevention of tuberculosis . . . 208 

on the pollution of water-supplies 191 

on sanitary and medical service on board emigrant ships 143 

discussed 263 

on yellow-fever 120 

Conservation of nerve forces, by Mrs. Coleman Stuckert . .117 

Constitution 301 

Consumption (See tuberculosis). 

Contreras, Dr. Angel 274 

on hygiene of hair-dressers' and barbers' shops . . 81 
Contribution to the study of yellow-fever firom a medico-geo- 
graphical and prophylactic point of view in the Mexican 

republic, by Dr. Eduardo Lic^aga 122 

Cooperative housekeeping 116 

Cows, tuberculosis in 197 

Crothers, Dr. T. D., on influence of inebrity on public health . . . . . 74 

I> 

Daly, Dr. R. H., concerning leprosy 251 

« Dangers to Health," by Mr. Pridgen Teale 173 

Davison, Dr. J. H., remarks by 280 

Dead, disposal of the, in Hull, Eng 32 

Death-rate in England 187 

of Minneapolis lowered by sanitary work 170 

Deaths from all causes and from typhoid fever in Chicago, 1892, 1893 • • • ^49 

Diarrhoea, deaths from, by ages, in Hull, Eng. 29 

suppression of milk in 41 

tropical 33 



INDEX, 3SI 

Diarrhoea, bacteriology of 36 

treatment of 36 

Diffloulties and dangers that have presented themselves in the 
quarantines of several ports of the Mezioan republic, by Dr. 

Domingo Orvafianos 104 

Diseases, contagions and infectious, in Minneapolis, Minn 169 

infectious 9 

of Brazil, especially of Rio de Janeiro, brief notice of ... . 182 

Disinfection, an experiment in 21 

at the quarantine stations of Canada, methods of . . . .101 

by burning sulphur 283 

of baggage at the Canadian quarantine 279 

Drainage 4 

Durgin, Dr. Samuel H., president 262 

address of i 

closing remarks of 293 

£: 
El tifo de Enero de 1889 a Jnnio de 1898 en el hospital Juarez, 

by Dr. Luis £. Ruiz 258 

Emigrant ships, sanitary and medical service on 143 

Excreta, disposal of, at the world's Columbian exposition 60 

Explanation of the scientiflc principles, and of the data acquired 
through experience, on which the ordinances of the inter- 
national maritime police were foimded, by Dr. Eduardo Lic^aga 137 

Fayrer, Sir Joseph, M. D., on tropical diarrhoea 33 

Fever, origin and dissemination of 235 

typhoid, deaths from, by ages, in Hull, Eng. 29 

in Chicago, 1892, 1893 I49 

discussed 264 

high death-rate from, reduced by water filtration .... 276 

in connection with the Centennial exposition in Philadelphia . 274 

typhus, from January, 1889, to June, 1893, ^^^ ^^ Juarez hospital, Mexico . 253 

some reflections concerning 258 

yellow, articles from the maritime sanitary public ordinance, Mexico . . 134 

centres of 123 

coloration of persons attacked by 89 

contribution to the study of, in the Mexican republic . . .122 

immunity from 129 

inoculation to obtain 130 

in Brazil 184 

prophylactic measures in 132 

report of international committee on 120 

Filters, experiments with, for bacteria 156 

Filtration by sand for the removal of pathogenic bacteria from drinking-water . 152 

Flick, Dr. Lawrence F., discussion on tuberculosis 269 

Food, prophylactic and therapeutic value of 161 

tables showing values of 164 

supply and tuberculosis 196 

Formento, Dr. FeluE, report of the international committee on yellow-fever . . 120 

Fuller, Mr. Geo. W 276* 274 

on the removal of pathogenic bacteria from drinking water by 

sand filtration 152 



352 INDEX, 

o 

Garbage, collection of, in Minneapolis 169 

Garcia, Dr. Eduardo R., on los ejerdcios fisicos : la higiene 2r8 

Gavifio, Dr. Angel, on las aguas potables de los campos presentan muchos peligros 231 

Gihon, Dr. Albert L. 262, 289^ 290, 291, 292, 293 

report of the committee on sanitary and medical service on 

board emigrant ships 143 

resolution in regard to the teaching of hygiene . . . 286 

Grosse Isle quarantine station 92 

Gutierrez, Dr. Manuel, on some considerations about the influence of habitation in 

the development of tuberculosis 202 

Habitations for the poor 1 1 

Hair-dressers' and barbers' shops, hygiene of 81 

Halifax, N. S., quarantine station 94 

Hamilton, Dr. John 6 285 

Hansen, Dr. G. A 288 

on leprosy 253 

Hart, Dr. Ernest 274 

on objects of the National Health Society of London . . . 71 

Hazen, Allen, S. B 268 

on the sewage disposal problem in American dties ... 44 

on the water-supply of Chicago, its source and sanitary aspect 146 

Health legislation, National discussion of resolutions on 289 

public, influence of inebriety on 74 

Health sodety, national, of London, objects of 71 

Henrotin, Mrs. Charles, remarks by 18 

Hewitt, Dr. C. N 263, 268, 276^ 278, 284, 285, 286, 288 

on leprosy 287 

on quarantine 277 

on typhoid fever 266 

resolution in regard to the formation of public health assodations 286 

resolution in relation to the Lamb prizes 286 

Hibberd, Dr. James F 262, 279 

Holton, Dr. Henry D., on quarantine 277 

treasurer, report 295 

Horlbeck, Dr. H. B., on yellow-fever 120 

How can women best promote public sanitation P by Sarah H. Bray^ 

ton, M. D 178 

How shall our lepers be cared for P by Benjamm Lee, M. D. . . 246 

discussed 287 

Hull, £ng., management of cholera in 25 

Hygiene among the ancients 2 

and sanitation, municipal 169 

of hair dressers' and barbers* shops, by Dr. Angel Contreas ... 81 

public, importance of, to the state 186 

resolution in relation to the teaching of 286 



Icaza, Dr. Ramon, on algunas reflexiones acerca de la infecdon y el contagio del 

tifo exantem&tico 258 

" Ictheroidine *' in the urine of yellow-fever patients 89 

Importance of civil public hygiene to the state, by Sir Charles A. 

Cameron 186 



INDEX. 353 

Importanoe of sanitary bureaus ; their eoonomio organism, by 

Dr. J. E. Monjaris 69 

discassed 284 

Influenoe of inebriety on public health, by T. D. Crowthers, M. D. . 74 

«T 

Jackson, Dr. George Thomas, concerning leprosy 251 

James, Dr. £. H., obituary 297 

Jones, Dr. E. U., obituary 297 

-EL 

Kagami, Dr. M 287 

Kelley, Dr. E. S 284 

on municipal hygiene and sanitation 169 

14 

Lachapelle, Dr. E. P. 282, 291, 292 

Ladies' Sanitary Association, of London, Eng., work of . . • . . .178 

La grippe in Orizaba, Mex 224 

sus formas y complicaciones en Orizaba su profilaxia, by Dr. Gregorio 

Mendizabal 224 

Las aguas potables de los campos presentan muchos peligros, by 

Dr Angel Gavifio 281 

Lawrence (Mass.) high death-rate from typhoid-fever reduced by water filtration . 276 

Lee, Dr. Benj 274, 288, 291 

on how shall our lepers be cared for 246 

resolution in relation to vacdnation 285 

Lepers, how shall they be cared for 246 

Leprosy 246, 250, 252, 287 

Lewis, Dr. R. H 281 

Lic^aga, Dr. Eduardo 274, 276, 285, 286 

on contribution to the study of yellow-fever from a medico- 
geographical and prophylactic point of view in the 

Mexican republic 122 

on explanation of the scientific principles, and of the data 
acquired through experience, on which the ordinances 

of the international maritime police were founded . 137 

vice-president's address 13 

Lomb, Mr. Henry, offers two prizes 286 

Los carros dormitorios no Ueman las oondiciones que la higiene 

ezigOy by Dr. Fernando T&rraga 220 

IiOS ejeroioios fisioos : La Higiene, by Dr Eduardo R. Garcia . . 218 

m: 

Macouzer, Dr. Roque 286 

Malaria in Brazil 185 

Marin, Dr. Frandsco 286 

on apuntes sobre la escarlatina un la dudad de Puebla, 

Mexico 215 

Marquez, Dr. Miquel 285 

Mason, Dr. John Wright 268 

on Notes on Cholera and its management in Hull . 25 

Mayer, Dr. F.J 280 

McCormack, Dr. J. N 262, 263, 268 

report of committee on pollution of water-supplies . . 191 
on restriction and prevention of tuber- 
culosis 208 



354 INDEX. 

Meat, tuberculotts, as a source of consumption 269 

Members, list of . . . • 313 

Mendizabal, Dr. Gregorio, on la grips, sus formas y complicadones en Orizaba su 

profilazia 224 

Mexican quarantines, difficulties and dangers at 104 

Mexico, yellow-fever in 122 

Milk, suppression o^ in diarrhoea 41 

tuberculous, as a source of consumption 269 

Milwaukee, collection and disposal of animal and vegetable waste in ... 49 

Minneapolis, Minn., municipal hygiene and sanitation in 169 

Monjaras, Dr. Jesus E. 275 

on the importance of sanitary bureaus; their economic 

organism 69 

resolution of, relating to the teaching of hygiene . 290 

Montizambert, Dr. Frederick 262, 276^ 279^ 280^ 284, 292 

on the Canadian quarantine system .... 52 

Morse, Col. W. F. 268 

on the disposal of the garbage and waste of the World's Col- 

umtnan exposition 53 

Munioipal hygiene and sanitation, by E. S. KeUy, M. D. . 169 

Mnnioipal sanitation, by Sarah Hackett Stevenson, M. D 242 

Murphy, Mr. Henry 288 

National Health Society of London, Eng 172 

National registration a necessity, by S. w. Abbott, M. D. ... 68 

discussed 284 

Necrology 297 

Nerve forces, conservation of 116 

Nomenclature of diseases, discussion on 290 

Notes on oholera and its management in Hull, by Dr. John Wright 

Mason 26 

o 

Objects of the ITational Health Sooiety of London, by Dr. Ernest 

Hart 71 

Officers and Committees 308 

Oldright, Dr. William 270,278,287 

on overwork and unrest 210 

Olliphant, Dr. S. R., on quarantine 107 

On the removal of pathogenic bacteria fM>m drinking water by 

sand filtration, by George W. Fuller, S. B 162 

Ordinances of the international maritime police, explanation of .... 137 
maritime sanitary police, articles from, Mexico . • . •134 

Origin and dissemination of typhoid fever, discussed 264 

Orme, Dr. H. S., on leprosy 248 

Orvananos, Dr. Domingo 274, 276^ 277 

on difficulties and dangers that have presented them- 
selves in the quarantines of several ports of the 

Mexican republic 104 

Overwork and unrest, by Dr. William Oldright 210 

IP 

Phthisis (see tuberculosis). 

Pictou, N. S., quarantine station 96 

Piffard, Dr. H. G., concerning leprosy 250 

Plunket, Dr. J. D 262, 263, 283, 290 



INDEX. 355 

Pneumonia, how an epidemic of, was checked 21 

Port Hawkesbury, N. £., qnarantine station 96 

Priestley, Lady 268 

on the progress of sanitary knowledge among the women of Eng- 
land 172 

Probst, Dr. C. 282,283 

on typhoid fever 265 

Proceedings and discussions at the twenty-first annual meeting .... 261 
Frophylaotio and therapeutio Talue of food, by Ellen H. Richards, 

M.S 161 

Q 

Qnarantiney by Dr. s. R. Olliphant 107 

discussed 277 

Quarantines of the Mexican republic, difficulties and dangers at several 104 

Quarantine provisions of Canada, general 98 

stations of Canada 92 

unorganized 96 

methods of disinfection at loi 

System of Canada 92 

of Texas iii 

Qttimby, Dr. I. N 271 

R 

Ranch, Dr. John H 263, 291 

resolution suspending immigration during the prevalence of 

cholera 292 

Redden, Dr. J. W., obituary 300 

Registration, national, a necessity 63 

Reynolds, Dr. A. R., remarks of 19 

on the water-supply of Chicago: its source and sanitary 

aspect 146 

Remarks, by Dr. Sarah Hackett Stevenson SM) 

Remarks, by Mrs. Charles Henrotin 18 

Removal of pathogenic bacteria from drinking-water, discussed .... 274 

Renwick, Dr. Arthur 287 

Report, necrology 297 

treasurer's 295 

Report of the committee on the pollution of water-supplies, by 

Dr. J. N. McCormack, chairman . . 191 
on sanitary and medical service on 
board emigrant ships, by Albert L. 

Gihon, M. D., chairman . • • • 148 

Report of the international committee on yellow-fever, by Dr. 

Felix Formento, chairman 120 

Resolutions : formation of public health associations 286, 290 

national health legislation 268 

thanks 293 

the teaching of hygiene 286 

vaccination for small-pox 285 

Richards, Mrs. Ellen H 274 

on the prophylactic and therapeutic value of food . . 161 

Rio de Janeiro, climate and diseases of 182 

Rogers, Mrs. Henry Wade 268 

Ruiz, Dr. Luis £., on el tifo de Enero de 1889 i Junio 1893 ^'^ ^ hospital Juarez 252 



3S6 INDEX. 

Salmon, Dr. D. £ 269, 272 

on tuberculosis 272 

and the food-supply 196 

Salomon, Dr. L. F 282 

Sanitary associations of London, Eng., work of women's 172,178 

bureaus, importance of; their economic organism 69 

knowledge among the women of England, progress of . .172 

and medical service on board emigrant ships, report of committee on 143 

organizations, voluntary 176 

science, aims of i 

service in Mexico, organization of 140 

work in Dublin 188 

Sanitation and hygiene, municipal 169 

modern 3 

municipal 4, 242 

public, how can women best promote it ? 178 

Scarlatina in Puebla, Mez. 215 

Scurf contracted in barbers' shops 81 

Sedgwick, Prof. W. T 276 

on the origin and dissemination of typhoid fever . 235 

on typhoid fever 266 

Semiology, symptoms of ' ... 34 

Septien, Dr. Manuel, on cholera infantum : its treatment 39 

Sewage disposal problem in American cities 44 

Sharp, Dr. Joseph 262, 290, 291 

Sherwell, Dr. Samuel, concerning leprosy 251 

Small-pox in Brazil 185 

Smith, Dr. Joel W., on tuberculosis 272 

Some oonsiderations about the influence of habitation in the 

development of tuberculosis, by Manuel Gutierrez .... 202 

State boards of health, list of 343 

Statistics, mortality 8 

Steam disinfection of baggage at the Canadian quarantine 279 

Stevenson, Dr. Sarah Hackett 20, 284 

on municipal sanitation 242 

St. John, N. B., quarantine station 95 

Streets 7 

Stuckert, Mrs. Coleman, on conservation of nerve forces 1 16 

Sulphur as a disinfectant 283 

Swearingen, Dr. R. M., on the quarantine system of Texas 1 1 1 

Sweet, Miss Ada C, on voluntary public health and sanitary organizations . « . 176 

Sydney (N. S.) quarantine station 95 

Syphilitic cojitagion, can it form the vehicle for tuberculosis as well ? ... 204 

discussed 269 
T 

Tarraga, Dr. Fernando, on los carros dormitorios no Ileman las condiciones que 

la higiene exige 220 

Texas, quarantine system of ill 

The Canadian quarantine system, by Dr. Frederick Montizambert . 92 

The collection and disposition of animal and vegetable waste in 

the city of Milwaukee, by Dr. u. O. B. Wingate .... 49 
The disposal of the garbage and waste of the world's Columbian 

exposition, by Col. W. F. Morse 68 

The origin and dissemination of typhoid fever, by Prof. W. T. Sedg- 
wick 286 



INDEX. 357 

The President's address 1 

The progress of sanitary knowledge among the women of Eng- 
land, by Lady Priestley 172 

The quarantine system of Texas, by Dr. R. M. Swearingen • .111 

The sewage disposal problem in Amerioan cities, by Allen Hazen , 44 
The water-supply of Chicago : Its source and sanitary aspect, 

by Arthar R. Reynolds, M. D. and Allen Hazen, S. B 146 

Treasurer's report 295 

Tropical diarrhooa, by Surgeon-G«neral Sir Joseph Fayer .... 88 
Tuberculosis (See also phthisis). 

Tuberculosis and the food-supply, by D. £. Salmon, D. v. M. . . 196 

can syphilitic contagion form the vehicle of contagion of • . 204 

discussion on • 269 

and habitation • • • • 202 

discussed 269 

in the cow 197, 271 

report of the conmiittee on the restriction and prevention • • 208 

and tuberculous meat 269 

Typhoid fever (See Fever, typhoid). 

XJ 

Urine of yellow-fever patients, *' ictheroidine "in 89 

V 

Vaccination as a preventive of small-poz, resolution 285 

Vaccine, animal preferred to human 84 

Vice-President's address, by Dr. Eduardo Lic^agea 18 

Voluntary public health and sanitary organisations, by Miss Ada 

C. Sweet 176 

« Vomito prieto,*' yellow coloration of persons attacked by 89 



Walcott, Dr. Henry P., resolution concerning national health legislation • . 268 
Waste, the collection and disposition of animal and vegetable, in the dty of Mil- 
waukee 49 

and garbage, disposal of at the World's Columbian exposition • • • 53 
Water, drinking, removal of pathogenic bacteria by sand filtration • • . .152 

experiments with filtered 156 

potable, in Mexico 231 

Water-supply 4 

of Chicago, source and sanitary aspect ...... 146 

discussed • • • . 274 

of Minneapolis 171 

and typhoid fever 274 

discussed 264 

Water-supplies, pollution of, report of committee on 191 

White, Dr. James C, on leprosy 250 

Wmgate, Dr. U. O. B 268 

on the collection and disposition of animal and vegetable 

waste in the city of Milwaukee * 49 

Women of England, progress of sanitary knowledge among 172 

how can they best promote public sanitation 178 

Wood, Dr. T. F., obituary 298 

Y 
Yellow-fever (see Fever, yellow) 

Yellow coloration of persons attacked by ** vomito prieto," by 

Dr. Manuel Carmona y Valle 88 



••:• •■••>•, 



'■^\^:::<[yyf<^:-p 



,-.• .' •.♦.• .• •.%• 



.<•:•.•• 



y >•:? 









:•:-.> 



:.:•>! 



••■.•'.•>. ''V.:. 






t^ 



•;;:^ 

i-''.-:^ 












;#>;x:'x-:>^ 






•X*>. **.*I«.*. ■•.•■•1-. *•'.•. . . *\vr 






:-i ••: . 









.XK,